{"hospital_name":"Adventhealth Waterman","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Adventhealth Waterman"],"hospital_address":["1000 Waterman Way, Tavares, FL 32778"],"license_information":{"license_number":"4409","state":"FL"},"type_2_npi":["1821019571","1851940035"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Tim Reiner "},"modifier_information":[{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"AdventHealth","plan_name":"AMPS HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"ASA PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"International PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"QHP Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance/Health First","plan_name":"Employee HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"AvMed","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPC PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"CastCare Disney HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"County of Volusia HMO Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Surefit EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health First Health Plans","plan_name":"HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optimum 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modified price is presented in the standard charge value."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Global Transplant Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge 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(4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"60505615904","type":"NDC"}],"standard_charges":[{"gross_charge":105.68,"discounted_cash":105.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"47335005040","type":"NDC"}],"standard_charges":[{"gross_charge":5565.76,"discounted_cash":5565.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ 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Type: Pharmacy | NDC EA = 22 GR"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"67877047379","type":"NDC"}],"standard_charges":[{"gross_charge":136.4,"discounted_cash":136.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35.44 GR"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"59762013102","type":"NDC"}],"standard_charges":[{"gross_charge":112.61,"discounted_cash":112.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 GR"}]},{"description":"SILVER SULFADIAZINE 1 % EX 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Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"58602060407","type":"NDC"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 GR"}]},{"description":"AMMONIUM LACTATE 12 % EX LOTN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904598426","type":"NDC"}],"standard_charges":[{"gross_charge":61.15,"discounted_cash":61.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 226 GR"}]},{"description":"MUPIROCIN 2 % EX 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Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802005535","type":"NDC"}],"standard_charges":[{"gross_charge":38.11,"discounted_cash":38.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"42291007715","type":"NDC"}],"standard_charges":[{"gross_charge":41.26,"discounted_cash":41.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"CAPSAICIN 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536126456","type":"NDC"}],"standard_charges":[{"gross_charge":138.71,"discounted_cash":138.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42.5 GR"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672127502","type":"NDC"}],"standard_charges":[{"gross_charge":98.71,"discounted_cash":98.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"AYR SALINE NASAL NA GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00225052547","type":"NDC"}],"standard_charges":[{"gross_charge":43.96,"discounted_cash":43.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.1 GR"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"33342040530","type":"NDC"}],"standard_charges":[{"gross_charge":102.59,"discounted_cash":102.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"16714049601","type":"NDC"}],"standard_charges":[{"gross_charge":94.1,"discounted_cash":94.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"ZINC OXIDE 20 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"75834017001","type":"NDC"}],"standard_charges":[{"gross_charge":80.28,"discounted_cash":80.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00713065615","type":"NDC"}],"standard_charges":[{"gross_charge":55.56,"discounted_cash":55.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802006535","type":"NDC"}],"standard_charges":[{"gross_charge":59.2,"discounted_cash":59.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"NYSTATIN 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68382037001","type":"NDC"}],"standard_charges":[{"gross_charge":106.22,"discounted_cash":106.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"GENTAMICIN SULFATE 0.1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00713068215","type":"NDC"}],"standard_charges":[{"gross_charge":121.97,"discounted_cash":121.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"FLUOCINONIDE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672138601","type":"NDC"}],"standard_charges":[{"gross_charge":130.71,"discounted_cash":130.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672201301","type":"NDC"}],"standard_charges":[{"gross_charge":36.22,"discounted_cash":36.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.2 GR"}]},{"description":"NYSTATIN 100000 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802004811","type":"NDC"}],"standard_charges":[{"gross_charge":100.65,"discounted_cash":100.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"NYSTATIN 100000 UNIT/GM EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"gross_charge":100.65,"discounted_cash":100.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"NYSTATIN 100000 UNIT/GM EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00713067831","type":"NDC"}],"standard_charges":[{"gross_charge":98.23,"discounted_cash":98.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802043401","type":"NDC"}],"standard_charges":[{"gross_charge":49.26,"discounted_cash":49.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"ESTRADIOL 0.1 MG/GM VA CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00093354143","type":"NDC"}],"standard_charges":[{"gross_charge":140.62,"discounted_cash":140.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42.5 GR"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60505082901","type":"NDC"}],"standard_charges":[{"gross_charge":103.04,"discounted_cash":103.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 GR"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054327099","type":"NDC"}],"standard_charges":[{"gross_charge":139.24,"discounted_cash":139.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 GR"}]},{"description":"LIDOCAINE 4 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"39328002455","type":"NDC"}],"standard_charges":[{"gross_charge":44.33,"discounted_cash":44.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 GR"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68462018117","type":"NDC"}],"standard_charges":[{"gross_charge":156.16,"discounted_cash":156.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"NYSTATIN 100000 UNIT/GM EX 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9573","type":"HCPCS"},{"code":"00270702540","type":"NDC"}],"standard_charges":[{"gross_charge":5.83,"discounted_cash":5.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"VUEWAY 0.5 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9573","type":"HCPCS"},{"code":"00270703042","type":"NDC"}],"standard_charges":[{"gross_charge":67.49,"discounted_cash":67.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 ML"}]},{"description":"MULTIHANCE 529 MG/ML IV 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SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9577","type":"HCPCS"},{"code":"00270516415","type":"NDC"}],"standard_charges":[{"gross_charge":154.11,"discounted_cash":154.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"GADAVIST 1 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9585","type":"HCPCS"},{"code":"50419032513","type":"NDC"}],"standard_charges":[{"gross_charge":87.55,"discounted_cash":87.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"PRIVIGEN 20 GM/200ML IV 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Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9494.45,"10th_percentile":9494.45,"90th_percentile":9494.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12690.99,"10th_percentile":12690.99,"90th_percentile":12690.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7950.81,"maximum":27137.48,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":20680.59},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14267.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23578.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8507.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14147.44},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13302.8},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18085.86},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15479.55},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16285.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8189.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8189.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14045.12},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22468.32},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25275.42},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17906.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27137.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8507.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19668.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8507.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8348.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14101.1},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7950.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8070.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8348.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16897.89},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8427.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14934.16},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7950.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20567.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8348.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14934.16},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17153.38},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7950.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8507.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5954.84,"maximum":19670.67,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":14990.37},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10341.57},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17090.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6371.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":10254.8},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9642.57},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":13109.58},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11220.39},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11804.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6133.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6133.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10180.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16286.22},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18320.94},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12979.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19670.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6371.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14257.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6371.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6252.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10221.22},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5954.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6044.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6252.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12248.47},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6312.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10825.06},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5954.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14908.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6252.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10825.06},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12433.67},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5954.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6371.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13253.34,"maximum":46974.01,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":35797.36},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24695.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40813.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14181.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24488.71},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23026.67},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31305.98},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26794.55},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28189.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13650.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13650.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24311.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38891.87},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43750.85},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30995.2},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46974.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14181.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":34046.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14181.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13916.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24408.51},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13253.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13452.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13916.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29249.64},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14048.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25850.49},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13253.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35601.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13916.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25850.49},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29691.89},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13253.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14181.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":24695.9,"10th_percentile":24695.9,"90th_percentile":24695.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11844.38,"10th_percentile":11844.38,"90th_percentile":11844.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8920.98,"maximum":30766.87,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":23446.43},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16175.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26731.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9545.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16039.53},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15081.93},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20504.68},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17549.8},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18463.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9188.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9188.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15923.52},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25473.25},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28655.77},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20301.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30766.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9545.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22299.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9545.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9367.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15987.0},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8920.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9054.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9367.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19157.82},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9456.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16931.46},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8920.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23318.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9367.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16931.46},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19447.49},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8920.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9545.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6913.75,"maximum":23257.88,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":17724.08},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12227.49},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20207.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7397.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12124.91},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11401.02},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15500.29},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13266.58},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13957.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7121.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7121.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12037.22},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19256.23},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21662.02},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15346.42},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23257.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7397.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16857.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7397.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7259.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12085.2},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6913.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7017.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7259.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14482.15},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7328.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12799.16},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6913.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17627.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7259.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12799.16},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14701.12},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6913.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7397.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11234.94,"10th_percentile":11234.94,"90th_percentile":11234.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2842.74,"10th_percentile":2842.74,"90th_percentile":2842.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50908.37,"maximum":187839.82,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":143146.6},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":98754.05},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":163204.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54471.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":97925.53},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":92079.13},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":125186.46},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":107146.14},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":112725.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52435.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":52435.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":97217.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":155520.92},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":174951.01},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":123943.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187839.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54471.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":136144.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54471.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53453.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97604.81},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50908.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51672.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53453.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":116963.55},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53962.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":103371.03},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50908.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":142364.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53453.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":103371.03},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":118732.03},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50908.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54471.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32565.95,"maximum":119221.61,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":90854.9},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":62679.02},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103585.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":34194.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":74236.56},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34519.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":65609.42},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32565.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90358.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34194.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":65609.42},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":75359.02},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32565.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34845.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40748.2,"maximum":149831.04,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":114181.35},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":78771.49},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130180.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43600.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":78110.62},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":73447.22},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":99855.39},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":85465.47},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":89915.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41970.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":41970.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":77545.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":124051.77},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":139550.25},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":98864.08},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":149831.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43600.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":108595.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43600.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42785.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77854.8},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40748.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41359.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42785.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":93296.35},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43193.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":82454.24},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40748.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":113557.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42785.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":82454.24},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":94706.99},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40748.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43600.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24972.86,"maximum":90816.24,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":69208.09},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47745.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78905.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26720.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":47344.74},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":44518.14},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":60524.77},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":51802.69},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":54500.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25722.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25722.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":47002.32},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":75190.79},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":84584.79},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":59923.92},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90816.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26720.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":65822.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26720.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26221.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47189.68},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24972.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25347.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26221.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":56549.19},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26471.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":49977.52},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24972.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68830.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26221.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":49977.52},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":57404.21},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24972.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26720.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":63847.57,"maximum":236244.78,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":180034.44},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":124202.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":205261.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68316.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":123160.23},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":115807.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":157446.1},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":134756.92},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":141773.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65763.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":65763.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":122269.47},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":195597.54},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":220034.63},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":155883.07},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236244.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68316.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":171227.68},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68316.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67039.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":122756.87},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63847.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64805.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67039.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":147104.21},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67678.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":130009.0},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63847.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":179051.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67039.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":130009.0},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":149328.42},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63847.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68316.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":66609.79,"10th_percentile":66609.79,"90th_percentile":66609.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19856.52,"10th_percentile":19856.52,"90th_percentile":19856.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45508.9,"maximum":167640.63,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":127753.45},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":88134.62},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145654.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48694.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":87395.19},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":82177.48},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":111724.64},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":95624.27},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":100603.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46874.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":46874.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":86763.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":138797.12},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":156137.81},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":110615.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":167640.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48694.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":121504.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48694.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47784.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87108.96},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45508.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46191.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47784.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":104385.97},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48239.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":92255.12},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45508.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":127055.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47784.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":92255.12},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":105964.29},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45508.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48694.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47478.81,"10th_percentile":47478.81,"90th_percentile":47478.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47542.2,"10th_percentile":47542.2,"90th_percentile":47542.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32053.43,"maximum":117304.3,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":89393.78},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":61671.03},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101919.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34297.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":61153.63},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":57502.6},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":78177.83},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":66911.81},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":70395.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33015.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33015.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":60711.33},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":97121.44},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":109255.36},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":77401.73},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":117304.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34297.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":85020.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34297.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33656.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60953.34},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32053.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32534.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33656.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":73042.7},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33976.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":64554.29},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32053.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88905.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33656.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":64554.29},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":74147.1},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32053.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34297.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42201.58,"maximum":155268.1,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":118324.75},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":81629.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":134904.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45155.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":80945.09},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":76112.46},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":103478.93},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":88566.83},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":93178.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43467.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":43467.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":80359.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":128553.35},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":144614.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":102451.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155268.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45155.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":112536.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45155.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44311.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80679.98},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42201.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42834.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44311.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":96681.88},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44733.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":85446.33},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42201.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":117678.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44311.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":85446.33},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":98143.71},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42201.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45155.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22134.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43527.97,"maximum":160230.04,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":122106.09},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":84238.61},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139215.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":45704.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":99771.57},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46139.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":88176.96},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43527.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":121439.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45704.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":88176.96},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":101280.12},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43527.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24103.39,"maximum":87563.56,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":66729.33},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":46035.27},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76079.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25790.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":45649.04},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":42923.68},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":58357.02},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":49947.33},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":52548.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24826.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24826.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":45318.89},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":72497.76},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":81555.3},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":57777.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87563.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25790.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":63465.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25790.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25308.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45499.54},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24103.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24464.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25308.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":54523.82},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25549.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":48187.52},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24103.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66364.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25308.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":48187.52},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":55348.22},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24103.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25790.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":6519.55,"10th_percentile":6519.55,"90th_percentile":6519.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14401.62,"maximum":51269.68,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":39070.95},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26954.29},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44545.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15409.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26728.15},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25132.41},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34168.84},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29244.85},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30767.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14833.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14833.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26534.84},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42448.44},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47751.76},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33829.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51269.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":15121.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31924.45},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15265.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28214.46},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14401.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38857.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15121.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":28214.46},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32407.15},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14401.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15409.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39814.84,"maximum":146339.41,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":111520.49},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":76935.81},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":127147.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":41805.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":91122.19},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42203.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":80532.74},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39814.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110911.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41805.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":80532.74},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":92499.96},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39814.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42601.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27198.79,"maximum":99143.31,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":75553.88},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":52123.15},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86140.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29102.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":62027.08,"10th_percentile":62027.08,"90th_percentile":62027.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27776.78,"10th_percentile":27776.78,"90th_percentile":27776.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21347.66,"maximum":77254.52,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":58873.15},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":40615.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67122.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22842.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":40274.69},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":37870.19},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51486.53},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":44066.93},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":46361.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21988.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21988.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":39983.4},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":63962.45},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":71953.63},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":50975.4},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77254.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22842.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":55993.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22842.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22415.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40142.78},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21347.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21667.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22415.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":48104.62},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22628.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":42514.31},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21347.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58551.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22415.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":42514.31},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":48831.96},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21347.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22842.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21347.91,"10th_percentile":21347.91,"90th_percentile":21347.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23490.92,"maximum":85272.35,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":64983.28},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":44830.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74088.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25135.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":44454.58},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":41800.53},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":56830.04},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":48640.4},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":51173.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24195.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24195.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":44133.06},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":70600.76},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":79421.31},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":56265.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85272.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25135.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":61804.48},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25135.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24665.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44308.99},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23490.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23843.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24665.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":53097.14},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24900.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":46926.64},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23490.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64628.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24665.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":46926.64},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":53899.96},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23490.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25135.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15192.19,"maximum":54227.17,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":41324.75},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28509.14},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47115.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16255.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28269.96},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26582.17},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36139.87},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30931.84},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32542.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15647.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15647.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28065.5},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44897.08},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50506.32},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":35781.1},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54227.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":15951.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33766.01},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16103.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29842.01},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15192.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41099.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15951.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29842.01},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34276.55},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15192.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16255.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36983.97,"maximum":135749.24,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":103450.07},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":71368.19},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":117945.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39572.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":70769.43},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":66544.31},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":90470.52},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":77433.03},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":81465.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38093.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":38093.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":70257.59},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":112392.82},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":126434.68},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":89572.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":135749.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39572.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":98389.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39572.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38833.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70537.65},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36983.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37538.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38833.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":84527.94},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39203.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":74704.82},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36983.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102885.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38833.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":74704.82},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":85806.0},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36983.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39572.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22836.37,"maximum":82823.71,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":63117.25},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":43543.36},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71961.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24434.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":43178.04},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":40600.2},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":55198.13},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":47243.66},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":49703.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23521.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23521.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":42865.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":68573.42},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":77140.68},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":54650.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82823.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":23978.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":51572.42},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24206.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":45579.11},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22836.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62772.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23978.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":45579.11},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":52352.2},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22836.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24434.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":60052.34,"10th_percentile":60052.34,"90th_percentile":60052.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19042.84,"maximum":68632.27,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":52302.41},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":36082.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59631.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20375.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35779.69},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":33643.56},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":45740.2},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":39148.69},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":41187.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19614.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19614.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":35520.92},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":56823.7},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":63923.0},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":45286.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68632.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20375.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":49743.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20375.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19994.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35662.51},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19328.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19994.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":42735.74},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20185.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":37769.35},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19042.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52016.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19994.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":37769.35},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":43381.9},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19042.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20375.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17668.32,"10th_percentile":17668.32,"90th_percentile":17668.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32957.47,"maximum":120686.3,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":91971.09},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":63449.06},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":104858.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35264.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":62916.74},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":59160.45},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":80431.77},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":68840.94},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":72425.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33946.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33946.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":62461.7},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":99921.54},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":112405.29},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":79633.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":120686.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35264.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":87472.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35264.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34605.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62710.68},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32957.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33451.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34605.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":75148.59},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34934.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":66415.46},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32957.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91468.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34605.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":66415.46},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":76284.83},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32957.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35264.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17798.37,"maximum":63976.75,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":48754.6},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33634.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55586.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19044.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":33352.66},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31361.42},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42637.52},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":36493.13},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":38393.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18332.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18332.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33111.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":52969.19},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":59586.93},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":42214.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63976.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19044.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":46369.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19044.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18688.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33243.43},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17798.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18065.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18688.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39836.86},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18866.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35207.35},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17798.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48488.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18688.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":35207.35},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":40439.19},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17798.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19044.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18576.09,"10th_percentile":18576.09,"90th_percentile":18576.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9565.76,"maximum":33178.96,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":25284.6},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17443.36},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28827.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10235.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17297.01},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16264.34},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22112.23},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18925.69},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19911.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9852.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9852.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17171.91},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27470.34},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30902.36},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21892.71},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33178.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10235.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":24047.76},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10235.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10044.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17240.36},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9565.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9709.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10044.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20659.78},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10139.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18258.87},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9565.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25146.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10044.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18258.87},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20972.15},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9565.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10235.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26657.71,"maximum":97119.17,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":74011.35},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":51058.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84382.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":27990.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":60473.88},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28257.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":53446.12},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26657.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73607.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27990.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":53446.12},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":61388.24},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26657.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28523.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19177.35,"maximum":69135.49,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":52685.9},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":36346.98},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60068.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20519.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":36042.04},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":33890.24},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46075.57},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":39435.73},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":41489.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19752.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19752.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":35781.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":57240.34},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64391.69},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":45618.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69135.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20519.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20418.01,"10th_percentile":20418.01,"90th_percentile":20418.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2919.71,"10th_percentile":2919.71,"90th_percentile":2919.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14666.14,"maximum":52259.26,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":39825.07},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27474.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45405.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15692.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":27244.04},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25617.5},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34828.35},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29809.32},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":31361.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15106.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15106.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27047.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43267.76},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48673.44},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":34482.6},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52259.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15692.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":37876.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15692.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15399.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27154.81},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14666.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14886.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15399.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32540.64},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15546.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28759.04},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14666.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39607.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15399.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":28759.04},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":33032.65},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14666.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15692.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22582.37,"maximum":81873.49,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":62393.12},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":43043.79},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71135.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24163.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":42682.67},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":40134.41},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":54564.85},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":46701.64},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":49133.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23259.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23259.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":42373.97},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":67786.69},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":76255.66},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":54023.17},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81873.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":23711.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50980.74},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23937.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":45056.19},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22582.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62052.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23711.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":45056.19},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":51751.57},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22582.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24163.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16436.66,"maximum":58882.68,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":44872.57},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30956.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51160.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17587.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30696.99},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28864.3},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39242.55},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33587.4},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35336.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16929.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16929.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30474.98},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48751.58},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54842.39},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38852.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58882.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17587.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":42677.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17587.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17258.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30596.46},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16436.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16683.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17258.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36664.89},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17422.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32404.01},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16436.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44627.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17258.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32404.01},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":37219.27},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16436.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17587.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17159.56,"10th_percentile":17159.56,"90th_percentile":17159.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16445.0,"10th_percentile":16445.0,"90th_percentile":21543.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14616.33,"10th_percentile":14616.33,"90th_percentile":14616.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12953.49,"maximum":45852.3,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":34942.54},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24106.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39838.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13860.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23903.94},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22476.81},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30558.42},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26154.72},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27516.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13342.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13342.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23731.05},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37963.16},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42706.1},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30255.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45852.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13860.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33233.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13860.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13601.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23825.65},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12953.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13147.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13601.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28551.18},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13730.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25233.2},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12953.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34751.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13601.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25233.2},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28982.87},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12953.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13860.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21527.27,"maximum":77926.42,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":59385.19},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":40968.68},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67706.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23034.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":40624.97},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":38199.55},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51934.32},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":44450.19},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":46764.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22173.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22173.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":40331.15},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":64518.74},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":72579.43},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":51418.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77926.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23034.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":56480.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23034.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22603.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40491.92},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21527.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21850.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22603.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":48523.0},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22818.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":42884.06},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21527.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59060.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22603.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":42884.06},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":49256.66},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21527.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23034.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22483.08,"10th_percentile":22483.08,"90th_percentile":22483.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21523.96,"10th_percentile":21523.96,"90th_percentile":21523.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24948.07,"maximum":90723.46,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":69137.39},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47696.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78825.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26694.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":47296.38},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":44472.67},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":60462.95},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":51749.78},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":54444.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25696.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25696.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":46954.31},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":75113.98},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":84498.39},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":59862.71},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90723.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26694.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":65755.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26694.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26195.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47141.48},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24948.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25322.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26195.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":56491.42},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26444.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":49926.46},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24948.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68759.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26195.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":49926.46},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":57345.57},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24948.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26694.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16411.11,"maximum":58787.09,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":44799.73},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30906.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51077.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17559.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30647.16},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28817.45},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39178.85},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33532.88},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35278.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16903.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16903.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30425.51},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48672.44},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54753.36},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38789.91},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58787.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17559.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":42608.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17559.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17231.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30546.79},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16411.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16657.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17231.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36605.37},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17395.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32351.41},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16411.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44555.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17231.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32351.41},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":37158.85},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16411.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17559.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17473.36,"10th_percentile":17473.36,"90th_percentile":17473.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12466.53,"maximum":44030.58,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":33554.27},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23148.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38256.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13339.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22954.23},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21583.8},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29344.32},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25115.58},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26423.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12840.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12840.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22788.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36454.87},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41009.38},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29053.01},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44030.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13339.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31912.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13339.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13089.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22879.05},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12466.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12653.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13089.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27416.83},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13214.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24230.68},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12466.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33371.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13089.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24230.68},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27831.37},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12466.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13339.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13989.8,"maximum":49729.09,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":37896.91},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26144.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43207.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14969.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25925.0},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24377.21},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33142.11},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28366.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29843.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14409.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14409.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25737.5},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41172.92},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46316.88},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32813.1},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49729.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14969.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":36043.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14969.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14689.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25840.09},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13989.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14199.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14689.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30965.16},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14829.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27366.65},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13989.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37689.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14689.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27366.65},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31433.35},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13989.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14969.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13337.43,"10th_percentile":13337.43,"90th_percentile":13337.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9089.32,"maximum":31396.6,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":23926.32},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16506.3},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27278.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9725.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16367.82},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15390.62},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20924.36},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17909.0},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18841.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9362.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9362.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16249.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25994.64},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29242.29},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20716.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31396.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9725.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22755.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9725.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9543.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16314.21},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9089.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9225.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9543.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19549.94},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9634.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17278.01},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9089.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23795.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9543.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17278.01},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19845.54},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9089.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9725.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28288.45,"maximum":103219.69,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":78660.36},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":54266.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89682.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30268.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":53810.97},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":50598.32},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":68791.1},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":58877.78},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":61943.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29137.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29137.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":53421.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":85460.16},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":96137.17},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":68108.18},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103219.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":29702.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":64272.53},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29985.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":56803.32},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28288.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78230.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29702.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":56803.32},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":65244.33},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28288.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30268.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28290.48,"10th_percentile":28290.48,"90th_percentile":28290.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19755.25,"maximum":71297.38,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":54333.41},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":37483.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61946.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21138.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37169.08},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":34949.99},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47516.37},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":40668.9},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":42786.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20347.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20347.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":36900.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":59030.26},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":66405.24},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":47044.66},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71297.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":20743.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":44395.24},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20940.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39236.0},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19755.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54036.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20743.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":39236.0},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":45066.5},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19755.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21138.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19752.5,"10th_percentile":840.0,"90th_percentile":19760.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18394.62,"10th_percentile":18394.62,"90th_percentile":18394.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15775.35,"maximum":56408.73,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":42987.26},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29656.07},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49010.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16879.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":29407.26},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27651.58},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37593.78},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":32176.23},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33851.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16248.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16248.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29194.58},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46703.29},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":52538.2},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":37220.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56408.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16879.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":40884.44},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16879.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16564.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29310.95},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15775.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16011.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16564.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35124.42},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16721.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31042.56},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15775.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42752.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16564.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31042.56},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35655.51},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15775.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16879.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27943.51,"maximum":101929.3,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":77677.0},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":53587.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88561.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29899.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":53138.26},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":49965.77},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":67931.12},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":58141.73},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":61169.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28781.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":28781.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":52753.94},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":84391.79},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":94935.33},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":67256.74},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101929.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29899.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":73877.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29899.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29340.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52964.23},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27943.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28362.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29340.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":63469.04},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29620.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":56093.2},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27943.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77252.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29340.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":56093.2},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":64428.69},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27943.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29899.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14252.82,"maximum":50713.04,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":38646.75},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26661.64},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44062.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":14965.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31577.85},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15107.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27908.14},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14252.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38435.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14965.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27908.14},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32055.3},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14252.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15250.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9776.93,"maximum":33968.94,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":25886.62},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17858.67},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29513.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10461.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23367.68,"maximum":84811.3,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":64631.92},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":44588.3},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73688.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25003.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15837.72,"maximum":56642.07,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":43165.08},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29778.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49213.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16946.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":41053.56},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16946.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16629.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29432.2},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15837.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16075.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16629.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35269.72},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16787.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31170.97},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15837.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42929.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16629.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31170.97},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35803.0},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15837.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16946.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24479.89,"maximum":88972.02,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":67802.68},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":46775.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77303.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26193.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":46383.31},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":43614.11},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":59295.69},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":50750.73},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":53393.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25214.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25214.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":46047.84},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":73663.88},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":82867.12},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":58707.04},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88972.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":25703.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":55400.84},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25948.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":48962.62},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24479.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67432.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25703.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":48962.62},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":56238.5},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24479.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26193.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13833.49,"maximum":49144.34,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":37451.29},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25836.92},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42699.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14801.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35619.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14801.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14525.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25536.24},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13833.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14040.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14525.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30601.05},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14663.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27044.86},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13833.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37246.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14525.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27044.86},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31063.74},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13833.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14801.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10810.99,"maximum":37837.29,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":28834.56},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19892.4},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32874.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11567.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19725.51},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18547.85},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25216.78},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21582.85},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22706.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11135.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11135.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19582.85},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31327.17},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35241.05},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24966.45},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37837.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11567.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27424.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11567.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11351.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19660.91},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10810.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10973.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11351.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23560.41},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11459.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20822.42},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10810.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28677.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11351.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20822.42},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23916.64},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10810.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11567.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21671.56,"maximum":78466.19,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":59796.53},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":41252.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68175.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23188.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":40906.36},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":38464.15},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":52294.05},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":44758.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":47088.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22321.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22321.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":40610.51},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":64965.64},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":73082.16},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":51774.91},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78466.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":22755.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":48859.1},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22971.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":43181.11},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21671.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59469.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22755.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":43181.11},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":49597.85},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21671.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23188.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14743.55,"maximum":52548.82,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":40045.74},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27626.78},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45657.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15775.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":27395.0},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25759.45},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35021.33},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29974.49},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":31535.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15185.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15185.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27196.86},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43507.5},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48943.13},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":34673.66},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52548.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15775.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":38086.82},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15775.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15480.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27305.27},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14743.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14964.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15480.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32720.94},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15628.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28918.39},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14743.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39827.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15480.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":28918.39},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":33215.68},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14743.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15775.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14759.22,"10th_percentile":14759.22,"90th_percentile":14759.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14169.41,"maximum":50400.99,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":38408.95},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26497.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43790.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15161.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26275.28},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24706.58},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33589.9},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28749.34},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30246.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14594.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14594.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26085.24},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41729.21},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46942.68},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33256.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50400.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15161.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":36530.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15161.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14877.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26189.22},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14169.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14381.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14877.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31383.54},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15019.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27736.41},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14169.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38199.19},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14877.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27736.41},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31858.06},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14169.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15161.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10835.79,"maximum":37930.06,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":28905.26},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19941.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32955.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11594.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19773.88},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18593.33},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25278.61},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21635.77},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22762.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11160.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11160.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19630.86},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31403.98},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35327.45},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25027.66},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37930.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11594.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27491.3},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11594.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11377.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19709.11},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10835.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10998.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11377.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23618.18},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11485.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20873.47},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10835.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28747.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11377.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20873.47},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23975.28},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10835.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11594.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14271.61,"maximum":50783.32,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":38700.31},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26698.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44123.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":14985.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31621.61},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15127.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27946.81},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14271.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38488.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14985.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27946.81},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32099.73},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14271.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15270.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12077.25,"maximum":42574.33,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":32444.51},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22382.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36990.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12922.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22195.05},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20869.95},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28373.8},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24284.92},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25549.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12439.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12439.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22034.52},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35249.17},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39653.05},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28092.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42574.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12922.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30857.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12922.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12681.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22122.36},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12077.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12258.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12681.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26510.06},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12801.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23429.28},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12077.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32267.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12681.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23429.28},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26910.89},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12077.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12922.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23395.48,"maximum":84915.32,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":64711.19},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":44642.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73778.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25033.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":44268.45},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":41625.51},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":56592.09},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":48436.74},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":50958.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24097.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24097.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":43948.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":70305.16},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":79088.77},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":56030.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84915.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":24565.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":52874.82},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24799.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":46730.16},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23395.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64357.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24565.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":46730.16},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":53674.29},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23395.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25033.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16323.19,"maximum":58458.17,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":44549.07},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30733.53},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50791.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17465.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30475.69},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28656.21},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38959.64},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33345.26},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35081.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16812.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16812.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30255.27},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48400.11},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54447.01},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38572.87},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58458.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":17139.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36400.56},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17302.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32170.4},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16323.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44305.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17139.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32170.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":36950.94},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16323.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17465.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17042.65,"10th_percentile":17042.65,"90th_percentile":17042.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13136.86,"maximum":46538.26,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":35465.29},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24466.81},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40434.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14056.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24261.54},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22813.07},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31015.57},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26545.99},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27928.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13530.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13530.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24086.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38531.09},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43344.99},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30707.67},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46538.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14056.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33730.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14056.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13793.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24182.08},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13136.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13333.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13793.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28978.31},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13925.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25610.69},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13136.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35271.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13793.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25610.69},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29416.46},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13136.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14056.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12527.4,"maximum":44258.3,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":33727.8},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23268.15},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38453.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13404.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23072.94},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21695.43},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29496.08},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25245.47},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26560.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12903.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12903.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22906.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36643.41},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41221.47},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29203.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44258.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13404.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":32077.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13404.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13153.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22997.37},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12527.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12715.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13153.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27558.63},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13279.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24356.0},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12527.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33543.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13153.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24356.0},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27975.31},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12527.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13404.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8379.16,"maximum":28739.92,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":21901.76},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15109.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24970.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":8798.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17895.69},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8881.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15816.0},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8379.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21782.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8798.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15816.0},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18166.27},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8379.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8965.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24645.97,"maximum":89593.32,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":68276.15},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47102.38},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77843.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26371.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":46707.21},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":43918.67},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":59709.76},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":51105.13},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":53766.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26371.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21617.47,"10th_percentile":21617.47,"90th_percentile":21617.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25748.85,"10th_percentile":25748.85,"90th_percentile":25748.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16313.42,"maximum":58421.63,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":44521.21},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30714.32},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50759.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17455.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30456.63},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28638.3},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38935.28},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33324.41},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35059.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16802.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16802.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30236.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48369.86},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54412.97},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38548.76},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58421.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17455.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":42343.37},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17455.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17129.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30356.88},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16313.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16558.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17129.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36377.81},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17292.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32150.29},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16313.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44278.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17129.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32150.29},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":36927.84},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16313.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17455.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15270.05,"10th_percentile":15270.05,"90th_percentile":15270.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12244.84,"maximum":43201.25,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":32922.26},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22712.43},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37535.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13101.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22521.88},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21177.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28791.61},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24642.52},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25925.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12612.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12612.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22358.99},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35768.23},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40236.95},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28505.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43201.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13101.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31311.8},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13101.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12857.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22448.11},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12244.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12428.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12857.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26900.43},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12979.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23774.29},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12244.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32742.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12857.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23774.29},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27307.16},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12244.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13101.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12802.61,"10th_percentile":12802.61,"90th_percentile":12802.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":2370.79,"10th_percentile":2370.79,"90th_percentile":2370.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28782.18,"maximum":105066.71,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":80067.92},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":55237.29},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91287.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30796.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":54773.87},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":51503.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":70022.05},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":59931.34},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":63051.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29645.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29645.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":54377.72},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":86989.39},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":97857.46},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":69326.92},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105066.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30796.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":76151.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30796.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30221.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54594.48},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28782.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29213.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30221.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":65422.63},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30509.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":57819.77},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28782.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79630.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30221.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":57819.77},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":66411.82},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28782.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30796.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15728.0,"maximum":56231.62,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":42852.28},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29562.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48856.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16828.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":29314.93},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27564.76},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37475.75},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":32075.21},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33745.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16199.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16199.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29102.91},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46556.66},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":52373.24},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":37103.71},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56231.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16828.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":40756.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16828.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16514.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29218.92},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15728.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15963.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16514.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35014.14},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16671.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30945.09},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15728.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42618.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16514.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30945.09},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35543.55},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15728.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16828.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11923.2,"maximum":41998.01,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":32005.31},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22079.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36490.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12757.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22265.99,"maximum":80689.93,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":61491.16},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":42421.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70107.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23824.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":42065.65},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":39554.23},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":53776.07},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":46026.53},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":48423.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22933.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22933.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":41761.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":66806.78},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":75153.32},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":53242.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80689.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23824.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":58483.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23824.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23379.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41927.88},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22265.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22599.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23379.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50243.77},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23601.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":44404.86},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22265.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61155.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23379.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":44404.86},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":51003.45},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22265.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23824.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21532.69,"10th_percentile":21532.69,"90th_percentile":21532.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":38581.76,"10th_percentile":38581.76,"90th_percentile":38581.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16611.01,"maximum":59534.9,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":45369.6},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31299.61},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51726.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17773.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":31037.01},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":29184.02},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39677.23},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33959.44},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35727.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17109.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17109.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30812.54},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49291.59},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55449.86},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":39283.34},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59534.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17773.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":43150.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17773.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17441.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30935.36},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16611.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16860.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17441.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37071.02},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17607.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32762.94},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16611.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45121.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17441.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32762.94},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":37631.53},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16611.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17773.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17367.42,"10th_percentile":17367.42,"90th_percentile":17367.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15284.97,"10th_percentile":15284.97,"90th_percentile":15284.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":7359.75,"10th_percentile":7359.75,"90th_percentile":7359.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"1 through 10","median_amount":37071.02,"10th_percentile":37071.02,"90th_percentile":37071.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12477.8,"maximum":44072.75,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":33586.4},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23170.61},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38292.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13351.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22976.21},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21604.47},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29372.43},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25139.64},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26448.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12852.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12852.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22810.04},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36489.79},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41048.66},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29080.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44072.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13351.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31943.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13351.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13101.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22900.96},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12477.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12664.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13101.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27443.09},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13226.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24253.89},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12477.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33402.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13101.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24253.89},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27858.03},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12477.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13351.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6754.43,"maximum":22661.89,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":17269.89},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11914.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19689.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7227.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11814.2},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11108.86},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15103.09},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12926.62},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13599.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6957.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6957.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11728.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18762.78},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21106.92},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14953.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22661.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7227.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16425.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7227.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7092.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11775.51},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6754.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6855.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7092.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14111.04},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7159.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12471.17},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6754.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17175.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7092.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12471.17},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14324.4},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6754.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7227.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10330.78,"maximum":36040.87,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":27465.57},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18947.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31314.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11053.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18788.99},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17667.24},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24019.55},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20558.15},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21628.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10640.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10640.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18653.1},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29839.83},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33567.89},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":23781.1},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36040.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11053.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26122.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11053.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10847.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18727.46},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10330.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10485.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10847.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22441.82},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10950.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19833.82},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27315.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10847.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19833.82},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22781.14},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11053.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10009.64,"10th_percentile":10009.64,"90th_percentile":10009.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10331.07,"10th_percentile":10331.07,"90th_percentile":10331.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6765.7,"maximum":22704.06,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":17302.02},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11936.33},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19726.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7239.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11836.19},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11129.54},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15131.19},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12950.67},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13625.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6968.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6968.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11750.58},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18797.7},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21146.2},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14980.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22704.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7239.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16455.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7239.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7103.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11797.42},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6765.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6867.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7103.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14137.3},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7171.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12494.38},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6765.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17207.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7103.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12494.38},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14351.05},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6765.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7239.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7078.27,"10th_percentile":7078.27,"90th_percentile":7078.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7071.2,"10th_percentile":7071.2,"90th_percentile":7071.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7868.14,"maximum":26828.24,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":20444.92},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14104.55},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23309.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8418.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":13986.22},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13151.21},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17879.76},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15303.15},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16100.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8104.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8104.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13885.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22212.29},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24987.39},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17702.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26828.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8418.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19444.82},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8418.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8261.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13940.41},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7868.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7986.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8261.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16705.33},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8340.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14763.98},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7868.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20333.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8261.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14763.98},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16957.91},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7868.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8418.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6109.65,"maximum":20249.79,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":15431.71},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10646.03},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17594.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6537.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":10556.72},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9926.45},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":13495.54},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11550.73},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12152.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6292.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6292.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10480.37},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16765.7},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18860.34},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13361.57},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20249.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6537.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14676.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6537.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6415.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10522.14},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6109.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6201.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6415.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12609.08},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6476.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11143.76},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6109.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15347.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6415.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11143.76},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12799.73},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6109.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6537.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15498.8,"maximum":55374.18,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":42198.85},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29112.17},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48111.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16583.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28867.92},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27144.44},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36904.3},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31586.11},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33230.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15963.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15963.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28659.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45846.74},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51574.62},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":36537.94},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55374.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16583.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":40134.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16583.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16273.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28773.38},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15498.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15731.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16273.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34480.23},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16428.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30473.23},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15498.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41968.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16273.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30473.23},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35001.57},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15498.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16583.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10438.25,"maximum":36442.88,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":27771.93},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19159.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31663.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11168.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18998.57},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17864.31},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24287.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20787.47},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21869.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10751.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10751.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18861.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30172.68},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33942.32},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24046.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36442.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11168.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26413.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11168.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10960.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18936.35},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10438.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10594.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10960.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22692.15},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11064.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20055.06},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10438.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27620.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10960.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20055.06},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23035.25},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10438.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11168.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6613.9,"maximum":22136.18,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":16869.26},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11637.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19233.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":6944.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13783.69},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7010.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12181.87},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6613.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16777.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6944.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12181.87},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13992.1},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6613.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7076.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13971.77,"maximum":49661.61,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":37845.5},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26108.87},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43148.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14949.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25889.82},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24344.14},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33097.14},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28327.59},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29802.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14390.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14390.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25702.58},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41117.05},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46254.04},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32768.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49661.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":14670.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30923.15},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14810.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27329.52},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13971.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37638.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14670.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27329.52},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31390.71},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13971.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14949.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13978.38,"10th_percentile":13978.38,"90th_percentile":13978.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8421.99,"maximum":28900.16,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":22023.87},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15193.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25109.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9011.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15066.37},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14166.87},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19260.61},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16485.01},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17343.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8674.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8674.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14957.4},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23927.73},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26917.15},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19069.4},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28900.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9011.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20946.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9011.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8843.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15017.02},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8421.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8548.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8843.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17995.47},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8927.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15904.19},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8421.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21903.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8843.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15904.19},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18267.56},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8421.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9011.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8422.87,"10th_percentile":8422.87,"90th_percentile":8422.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6367.41,"maximum":21214.07,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":16166.55},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11152.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18431.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11059.42},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10399.14},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14138.19},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12100.77},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12730.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6558.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6558.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10979.43},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17564.07},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19758.45},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13997.83},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21214.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15375.73},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6685.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11023.2},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6367.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6462.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6685.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13209.51},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6749.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11674.42},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6367.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16078.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6685.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11674.42},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13409.24},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6367.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19346.44,"maximum":69768.03,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":53167.94},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":36679.53},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60618.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":20313.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":43442.95},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20507.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38394.38},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19346.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52877.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20313.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":38394.38},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":44099.81},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19346.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20700.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9364.36,"maximum":32425.53,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":24710.44},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17047.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28172.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":9832.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20190.64},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9926.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17844.25},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9364.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24575.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9832.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17844.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20495.92},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9364.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10019.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6980.63,"maximum":23508.09,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":17914.75},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12359.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20425.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":7329.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14637.95},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7399.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12936.85},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6980.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17816.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7329.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12936.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14859.27},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6980.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7469.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15207.22,"maximum":54283.39,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":41367.6},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28538.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47164.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16271.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28299.27},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26609.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36177.34},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30963.91},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32576.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15663.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15663.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28094.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44943.63},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50558.69},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":35818.2},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54283.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16271.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":39344.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16271.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15967.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28206.59},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15207.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15435.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15967.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33801.02},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16119.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29872.95},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15207.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41141.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15967.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29872.95},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34312.09},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15207.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16271.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9768.67,"maximum":33938.01,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":25863.05},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17842.42},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29487.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10452.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17692.72},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16636.42},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22618.1},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19358.66},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20366.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10061.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10061.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17564.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28098.79},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31609.32},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":22393.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33938.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10452.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":24597.91},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10452.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10257.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17634.78},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9768.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9915.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10257.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21132.42},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10354.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18676.59},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9768.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25721.81},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10257.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18676.59},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21451.94},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9768.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10452.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10202.8,"10th_percentile":10202.8,"90th_percentile":10202.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7265.45,"maximum":24573.57,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":18726.72},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12919.2},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21350.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7774.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17810.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7774.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7628.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12768.85},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7265.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7374.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7628.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15301.4},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7701.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13523.2},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7265.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18624.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7628.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13523.2},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15532.76},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7265.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7774.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13292.42,"maximum":47120.2,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":35908.77},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24772.76},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40940.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14222.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24564.92},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23098.33},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31403.41},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26877.94},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28277.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13691.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13691.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24387.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39012.9},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43887.0},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31091.66},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47120.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":13957.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29340.67},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14089.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25930.94},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13292.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35712.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13957.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25930.94},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29784.3},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13292.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14222.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7920.75,"maximum":27025.03,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":20594.89},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14208.01},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23480.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8475.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14088.81},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13247.68},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18010.92},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15415.41},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16218.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8158.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8158.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13986.92},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22375.22},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25170.68},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17832.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27025.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8475.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19587.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8475.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8316.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14042.67},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7920.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8039.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8316.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16827.86},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8396.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14872.27},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7920.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20482.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8316.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14872.27},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17082.3},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7920.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8475.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":24926.22,"10th_percentile":24926.22,"90th_percentile":24926.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6380.08,"10th_percentile":6380.08,"90th_percentile":6380.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":21675.22,"10th_percentile":21675.22,"90th_percentile":21675.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6049.2,"10th_percentile":6049.2,"90th_percentile":6049.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7921.8,"10th_percentile":7476.11,"90th_percentile":7931.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6343.29,"10th_percentile":6343.29,"90th_percentile":6343.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10438.25,"maximum":36442.88,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":27771.93},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19159.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31663.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11168.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18998.57},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17864.31},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24287.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20787.47},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21869.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10751.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10751.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18861.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30172.68},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33942.32},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24046.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36442.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11168.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26413.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11168.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10960.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18936.35},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10438.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10594.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10960.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22692.15},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11064.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20055.06},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10438.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27620.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10960.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20055.06},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23035.25},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10438.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11168.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6934.79,"maximum":23336.6,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":17784.06},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12268.88},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20276.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7420.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12165.95},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11439.61},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15552.75},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13311.48},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14004.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7142.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7142.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12077.96},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19321.41},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21735.34},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15398.36},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23336.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7420.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16914.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7420.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7281.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12126.1},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6934.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7038.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7281.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14531.17},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7350.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12842.48},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6934.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17686.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7281.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12842.48},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14750.88},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6934.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7420.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5659.76,"10th_percentile":5659.76,"90th_percentile":5659.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10629.88,"maximum":37159.76,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":28318.24},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19536.2},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32286.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11373.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19372.3},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18215.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24765.24},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21196.38},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22300.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10948.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10948.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19232.19},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30766.22},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34610.01},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24519.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37159.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11373.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26933.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11373.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11161.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19308.85},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10629.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10789.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11161.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23138.53},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11267.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20449.57},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10629.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28163.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11161.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20449.57},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23488.39},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10629.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11373.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6938.55,"maximum":23350.66,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":17794.77},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12276.27},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20288.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7424.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12173.27},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11446.5},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15562.12},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13319.5},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14013.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7146.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7146.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12085.23},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19333.05},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21748.43},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15407.63},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23350.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7424.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16924.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7424.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7285.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12133.4},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6938.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7042.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7285.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14539.92},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7354.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12850.21},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6938.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17697.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7285.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12850.21},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14759.76},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6938.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7424.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6949.92,"10th_percentile":6949.92,"90th_percentile":6949.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2919.71,"10th_percentile":2919.71,"90th_percentile":2919.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11870.59,"maximum":41801.22,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":31855.35},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21976.38},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36319.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12701.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21792.01},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20490.97},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27858.56},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23843.93},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25085.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12226.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12226.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21634.4},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34609.08},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38932.99},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27582.0},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41801.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12701.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30297.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12701.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12464.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21720.64},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11870.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12048.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12464.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26028.66},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12582.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23003.83},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11870.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31681.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12464.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23003.83},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26422.21},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11870.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12701.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10665.75,"10th_percentile":10665.75,"90th_percentile":10665.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7408.98,"maximum":25110.53,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":19135.92},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13201.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21817.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7927.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":13090.74},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12309.19},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16735.0},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14323.36},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15069.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7631.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7631.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12996.06},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20790.12},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23387.55},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16568.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25110.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7927.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18199.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7927.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7779.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13047.87},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7408.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7520.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7779.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15635.75},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7853.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13818.7},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7408.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19031.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7779.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13818.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15872.16},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7408.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7927.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7890.66,"10th_percentile":7890.66,"90th_percentile":7890.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14711.23,"maximum":52427.93,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":39953.62},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27563.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45552.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15741.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":27331.97},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25700.19},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34940.77},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29905.54},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":31462.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15152.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15152.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27134.3},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43407.41},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48830.54},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":34593.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52427.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15741.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":37999.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15741.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15446.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27242.46},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14711.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14931.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15446.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32645.67},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15593.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28851.87},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14711.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39735.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15446.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":28851.87},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":33139.27},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14711.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15741.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24477.05,"10th_percentile":24477.05,"90th_percentile":24477.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9159.21,"maximum":31658.05,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":24125.57},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16643.76},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27506.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9800.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16504.12},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15518.78},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21098.61},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18058.14},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18998.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9433.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9433.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16384.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26211.1},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29485.8},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20889.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31658.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9800.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22945.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9800.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9617.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16450.07},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9159.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9296.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9617.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19712.74},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9708.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17421.89},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9159.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23993.81},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9617.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17421.89},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20010.8},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9159.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9800.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18882.03,"10th_percentile":18882.03,"90th_percentile":18882.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":22410.0,"10th_percentile":22410.0,"90th_percentile":22410.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"1 through 10","median_amount":45329.52,"10th_percentile":45329.52,"90th_percentile":45329.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6737.9,"maximum":22600.04,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":17222.75},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11881.64},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19636.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7209.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11781.96},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11078.55},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15061.87},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12891.34},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13562.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6940.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6940.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11696.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18711.58},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21049.32},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14912.35},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22600.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7209.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16380.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7209.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7074.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11743.37},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6737.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6838.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7074.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14072.53},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7142.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12437.14},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6737.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17128.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12437.14},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14285.3},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6737.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7209.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3439.66,"10th_percentile":3439.66,"90th_percentile":3439.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11403.92,"maximum":40055.4,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":30524.92},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21058.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34802.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12202.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20881.87},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19635.17},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26695.05},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22848.09},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24037.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11746.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11746.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20730.84},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33163.64},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37306.96},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26430.04},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40055.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12202.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29031.72},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12202.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11974.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20813.48},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11403.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11574.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11974.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24941.58},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12088.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22043.08},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11403.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30358.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11974.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22043.08},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25318.7},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11403.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12202.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":22848.09,"10th_percentile":22848.09,"90th_percentile":22848.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4449.0,"10th_percentile":4449.0,"90th_percentile":4449.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7426.27,"maximum":25175.19,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":19185.19},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13235.49},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21873.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7946.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":13124.45},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12340.89},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16778.09},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14360.24},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15107.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7649.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7649.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13029.53},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20843.66},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23447.77},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16611.53},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25175.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7946.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18246.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7946.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7797.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13081.46},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7426.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7537.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7797.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15676.01},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7871.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13854.28},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7426.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19080.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7797.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13854.28},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15913.04},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7426.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7946.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":10088.19,"10th_percentile":10088.19,"90th_percentile":10088.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7430.48,"10th_percentile":7430.48,"90th_percentile":7502.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12296.69,"maximum":43395.23,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":33070.09},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22814.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37703.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13157.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22623.0},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21272.35},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28920.89},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24753.17},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26042.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12665.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12665.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22459.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35928.83},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40417.62},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28633.78},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43395.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13157.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31452.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13157.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12911.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22548.91},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12296.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12481.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12911.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27021.21},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13034.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23881.04},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12296.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32889.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12911.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23881.04},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27429.77},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12296.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13157.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12591.85,"10th_percentile":12591.85,"90th_percentile":12591.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8019.19,"maximum":27393.31,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":20875.55},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14401.63},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23800.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8580.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14280.81},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13428.21},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18256.36},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15625.48},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16439.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8259.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8259.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14177.52},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22680.13},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25513.69},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18075.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27393.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8580.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19854.37},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8580.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8420.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14234.04},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8019.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8139.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8420.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17057.18},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8500.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15074.94},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8019.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20761.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8420.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15074.94},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17315.09},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8019.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8580.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8540.22,"10th_percentile":8540.22,"90th_percentile":8540.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8030.22,"10th_percentile":8030.22,"90th_percentile":8030.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6327.58,"maximum":21065.07,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":16053.0},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11074.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18302.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6770.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":10981.74},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10326.1},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14038.88},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12015.77},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12641.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6517.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6517.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10902.32},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17440.71},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19619.67},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13899.52},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21065.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6770.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15267.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6770.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6643.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10945.77},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6327.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6422.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6643.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13116.74},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6707.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11592.42},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6327.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15965.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6643.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11592.42},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13315.06},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6327.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6770.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6739.52,"10th_percentile":6739.52,"90th_percentile":6739.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2286.69,"10th_percentile":2286.69,"90th_percentile":2286.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22798.8,"maximum":82683.14,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":63010.13},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":43469.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71839.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24394.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":43104.76},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":40531.3},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":55104.45},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":47163.48},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":49619.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23482.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23482.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":42793.01},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":68457.04},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":77009.76},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":54557.41},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82683.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24394.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":59927.85},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24394.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23938.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42963.59},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22798.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23140.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23938.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":51484.9},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24166.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":45501.76},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22798.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62666.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23938.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":45501.76},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":52263.35},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22798.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24394.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":700.0,"10th_percentile":700.0,"90th_percentile":700.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13393.12,"maximum":47496.91,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":36195.85},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24970.81},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41267.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14330.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24761.31},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23283.0},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31654.47},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27092.82},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28503.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13794.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13794.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24582.23},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39324.8},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44237.87},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31340.23},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47496.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14330.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":34425.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14330.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14062.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24680.22},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13393.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13594.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14062.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29575.24},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14196.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26138.25},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13393.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35998.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14062.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26138.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30022.42},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13393.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14330.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12638.44,"10th_percentile":12638.44,"90th_percentile":12638.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9311.01,"maximum":32225.93,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":24558.33},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16942.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27999.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9962.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16800.17},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15797.16},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21477.08},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18382.07},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19339.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9590.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9590.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16678.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26681.28},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30014.72},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21263.87},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32225.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9962.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23357.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9962.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9776.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16745.15},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9311.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9450.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9776.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20066.35},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9869.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17734.41},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9311.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24424.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9776.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17734.41},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20369.75},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9311.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9962.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49929.93,"maximum":184179.51,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":140357.19},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":96829.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":160024.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53425.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":96017.32},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":90284.84},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":122747.03},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":105058.25},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":110528.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51427.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":51427.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":95322.87},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":152490.39},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":171541.86},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":121528.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":184179.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53425.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":133491.33},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53425.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52426.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95702.85},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49929.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50678.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52426.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":114684.35},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52925.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":101356.71},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49929.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139590.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52426.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":101356.71},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":116418.38},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49929.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53425.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26783.96,"maximum":97591.47,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":74371.27},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":51307.29},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84792.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28658.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":50876.84},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":47839.36},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":65040.15},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":55667.37},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":58565.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27587.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":27587.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":50508.87},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":80800.31},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":90895.14},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":64394.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97591.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28658.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":70733.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28658.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28123.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50710.21},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26783.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27185.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28123.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":60767.97},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28391.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":53706.03},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26783.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73965.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28123.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":53706.03},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":61686.78},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26783.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28658.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14200.97,"maximum":50519.06,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":38498.93},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26559.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43893.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15195.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26336.83},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24764.46},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33668.59},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28816.69},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30317.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14627.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14627.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26146.35},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41826.97},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47052.65},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33334.35},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50519.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":14911.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31457.06},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15053.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27801.39},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14200.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38288.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14911.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27801.39},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31932.69},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14200.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15195.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37528.8,"maximum":137787.44,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":105003.31},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":72439.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":119716.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":39405.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":85797.07},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39780.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":75826.47},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37528.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":104429.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39405.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":75826.47},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":87094.32},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37528.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40155.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20616.46,"maximum":74519.13,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":56788.6},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":39177.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64746.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":21647.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":46401.35},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21853.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41008.98},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20616.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56478.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21647.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":41008.98},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":47102.94},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20616.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22059.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12768.63,"maximum":45160.72,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":34415.51},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23742.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39237.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":13407.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28120.55},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13534.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24852.61},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12768.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34227.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13407.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24852.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28545.73},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12768.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13662.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25033.74,"maximum":91043.95,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":69381.62},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47865.03},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79103.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":26285.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":56690.98},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26535.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":50102.83},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25033.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69002.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26285.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":50102.83},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":57548.15},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25033.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26786.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15778.6,"10th_percentile":15778.6,"90th_percentile":15778.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13682.44,"maximum":48579.26,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":37020.67},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25539.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42208.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14640.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25325.57},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23813.57},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32375.81},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27710.21},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29153.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14092.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14092.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25142.4},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40220.93},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45245.95},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32054.4},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48579.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14640.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35209.73},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14640.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14366.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25242.62},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13682.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13887.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14366.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30249.19},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14503.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26733.89},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13682.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36818.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14366.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26733.89},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30706.56},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13682.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14640.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":29153.09,"10th_percentile":29153.09,"90th_percentile":29153.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11541.44,"maximum":40569.87,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":30916.97},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21329.02},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35249.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12349.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21150.07},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19887.36},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27037.92},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23141.55},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24346.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11887.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11887.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20997.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33589.6},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37786.13},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26769.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40569.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12349.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29404.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12349.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12118.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21080.8},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11541.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11714.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12118.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25261.93},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12233.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22326.2},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11541.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30748.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12118.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22326.2},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25643.89},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11541.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12349.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15174.91,"maximum":54162.51,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":41275.48},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28475.15},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47059.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16237.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy Without Cc/Mcc","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13655.39,"maximum":48478.06,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":36943.55},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25486.63},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42120.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14611.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16783.85,"maximum":60181.5,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":45862.36},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31639.55},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52288.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15193.69,"maximum":54232.79,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":41329.04},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28512.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47120.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":15953.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33769.51},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16105.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29845.11},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15193.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41103.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15953.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29845.11},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34280.11},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15193.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16257.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15240.28,"maximum":54407.09,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":41461.87},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28603.73},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47271.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":16002.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33878.05},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16154.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29941.03},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15240.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41235.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16002.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29941.03},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34390.28},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15240.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16307.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9611.61,"maximum":33350.45,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":25415.29},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17533.51},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28976.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10284.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17386.41},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16348.4},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22226.52},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19023.51},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20014.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9899.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9899.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17260.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27612.32},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31062.08},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":22005.87},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33350.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10284.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":24172.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10284.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10092.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17329.47},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9611.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9755.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10092.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20766.56},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10188.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18353.25},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9611.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25276.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10092.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18353.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21080.55},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9611.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10284.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7210.59,"maximum":24368.35,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":18570.32},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12811.3},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21172.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7715.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12703.82},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11945.37},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16240.36},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13900.0},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14623.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7426.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7426.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12611.94},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20175.64},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22696.29},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16079.14},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24368.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7715.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17661.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7715.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7571.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12662.21},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7210.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7318.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7571.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15173.61},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7643.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13410.26},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7210.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18468.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7571.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13410.26},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15403.04},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7210.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7715.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16633.55,"maximum":59619.24,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":45433.88},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31343.95},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51800.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17797.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":43211.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17797.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17465.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30979.19},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16633.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16883.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17465.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37123.53},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17631.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32809.35},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16633.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45185.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17465.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32809.35},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":37684.84},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16633.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17797.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8831.56,"maximum":30432.32,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":23191.48},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15999.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26441.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9449.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15865.12},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14917.93},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20281.72},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17358.97},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18262.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9096.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9096.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15750.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25196.27},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28344.18},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20080.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30432.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9449.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22057.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9449.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9273.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15813.16},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8831.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8964.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9273.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18949.51},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9361.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16747.36},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8831.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23064.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9273.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16747.36},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19236.03},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8831.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9449.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13224.78,"maximum":46867.18,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":35715.95},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24639.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40720.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":13886.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29183.12},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14018.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25791.7},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13224.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35520.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13886.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25791.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29624.37},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13224.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14150.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9198.28,"maximum":31804.24,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":24236.97},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16720.61},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27633.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9842.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16580.33},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15590.45},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21196.04},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18141.53},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19086.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9474.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9474.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16460.42},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26332.14},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29621.96},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20985.62},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31804.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":9658.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19803.77},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9750.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17502.34},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9198.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24104.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9658.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17502.34},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20103.2},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9198.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9842.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6478.63,"maximum":21630.14,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":16483.63},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11371.73},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18793.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6932.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11276.33},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10603.1},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14415.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12338.1},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12980.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6672.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6672.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11194.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17908.55},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20145.97},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14272.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21630.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6932.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15677.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6932.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6802.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11239.4},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6478.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6575.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6802.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13468.59},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6867.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11903.39},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6478.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16393.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6802.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11903.39},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13672.24},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6478.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6932.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8524.2,"maximum":29282.5,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":22315.24},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15394.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25442.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9120.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15265.69},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14354.29},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19515.42},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16703.1},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17572.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8779.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8779.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15155.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24244.28},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27273.25},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19321.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29282.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9120.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21223.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9120.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8950.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15215.69},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8524.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8652.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8950.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18233.54},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9035.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16114.59},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8524.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22193.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8950.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16114.59},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18509.23},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8524.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9120.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5243.18,"maximum":17008.37,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":12961.52},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":8941.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14777.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5610.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":8866.88},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":8337.51},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":11335.28},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":9701.78},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":10206.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5400.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5400.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":8802.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":14081.98},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15841.32},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11222.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17008.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5610.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12327.48},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5610.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5505.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8837.84},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5243.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5321.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5505.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10590.72},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5557.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":9359.96},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5243.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12890.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5505.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":9359.96},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":10750.85},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5243.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5610.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11377.61,"maximum":39957.01,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":30449.93},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21006.81},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34716.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12174.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20830.57},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19586.94},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26629.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22791.97},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23978.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11718.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11718.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20679.92},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33082.18},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37215.32},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26365.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39957.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12174.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28960.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12174.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11946.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20762.35},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11377.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11548.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11946.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24880.31},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12060.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21988.93},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11377.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30283.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11946.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21988.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25256.5},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11377.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12174.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":7259.29,"10th_percentile":7259.29,"90th_percentile":7259.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7241.4,"maximum":24483.61,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":18658.16},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12871.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21272.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7748.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12763.91},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12001.87},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16317.18},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13965.75},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14692.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7458.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7458.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12671.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20271.07},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22803.65},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16155.2},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24483.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7748.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17745.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7748.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7603.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12722.11},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7241.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7350.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7603.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15245.38},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7675.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13473.69},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7241.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18556.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7603.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13473.69},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15475.89},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7241.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7748.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7558.01,"10th_percentile":7558.01,"90th_percentile":7558.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":13565.75,"10th_percentile":13565.75,"90th_percentile":13565.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7423.95,"10th_percentile":7423.95,"90th_percentile":7423.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7243.88,"10th_percentile":6876.92,"90th_percentile":7260.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2546.92,"10th_percentile":2546.92,"90th_percentile":2546.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"1 through 10","median_amount":2400.92,"10th_percentile":2400.92,"90th_percentile":2400.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11759.37,"maximum":41385.15,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":31538.27},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21757.64},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35957.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12582.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21575.1},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20287.01},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27581.27},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23606.6},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24835.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12112.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12112.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21419.06},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34264.6},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38545.47},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27307.46},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41385.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12582.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29995.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12582.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12347.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21504.44},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11759.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11935.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12347.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25769.58},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12464.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22774.86},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11759.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31366.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12347.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22774.86},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26159.22},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11759.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12582.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7580.32,"maximum":25751.51,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":19624.38},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13538.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22374.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8110.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":13424.9},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12623.4},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17162.18},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14688.98},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15453.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7807.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7807.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13327.8},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21320.82},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23984.54},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16991.8},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25751.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8110.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18664.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8110.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7959.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13380.93},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7580.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7694.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7959.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16034.87},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8035.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14171.44},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7580.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19517.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7959.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14171.44},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16277.32},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7580.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8110.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7933.58,"10th_percentile":7933.58,"90th_percentile":7933.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7584.24,"10th_percentile":7584.24,"90th_percentile":7584.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12068.23,"maximum":42540.59,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":32418.8},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22365.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36961.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12913.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22177.46},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20853.41},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28351.32},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24265.68},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25529.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12430.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12430.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22017.06},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35221.24},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39621.63},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28069.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42540.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12913.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30832.96},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12913.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12671.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22104.83},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12068.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12249.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12671.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26489.05},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12792.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23410.72},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12068.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32241.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12671.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23410.72},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26889.56},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12068.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12913.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18369.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11212.28,"maximum":39338.52,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":29978.6},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20681.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34179.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11997.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26904.2,"maximum":98041.28,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":74714.06},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":51543.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85183.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28787.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14751.81,"maximum":52579.74,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":40069.31},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27643.03},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45683.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15784.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":27411.12},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25774.6},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35041.94},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29992.13},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":31553.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15194.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15194.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27212.87},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43533.1},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48971.94},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":34694.07},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52579.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15784.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":38109.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15784.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15489.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27321.34},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14751.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14973.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15489.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32740.2},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15636.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28935.41},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14751.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39850.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15489.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":28935.41},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":33235.23},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14751.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15784.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":23992.13,"10th_percentile":23992.13,"90th_percentile":23992.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13272.58,"10th_percentile":13272.58,"90th_percentile":13272.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11355.07,"maximum":39872.67,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":30385.66},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20962.47},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34643.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12149.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20786.6},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19545.59},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26573.27},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22743.86},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23928.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11695.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11695.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20636.27},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33012.35},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37136.77},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26309.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39872.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12149.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28899.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12149.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11922.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20718.53},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11355.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11525.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11922.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24827.8},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12036.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21942.52},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11355.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30219.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11922.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21942.52},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25203.19},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11355.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12149.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22395.25,"maximum":81173.48,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":61859.66},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":42675.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70527.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23962.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":42317.73},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":39791.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":54098.33},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":46302.35},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":48713.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13613.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12032.16,"maximum":42405.65,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":32315.96},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22294.15},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36844.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12874.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22107.11},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20787.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28261.38},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24188.7},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25448.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27443.77,"maximum":100059.79,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":76252.3},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":52604.98},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86937.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":28815.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":62304.93},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29090.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":55064.38},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27443.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75835.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28815.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":55064.38},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":63246.98},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27443.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29364.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14177.67,"maximum":50431.91,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":38432.51},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26513.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43817.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15170.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26291.4},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24721.74},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33610.51},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28766.98},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30264.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14603.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14603.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26101.25},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41754.82},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46971.48},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33276.85},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50431.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15170.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":36552.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15170.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14886.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26205.29},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14177.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14390.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14886.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31402.79},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15028.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27753.43},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14177.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38222.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14886.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27753.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31877.6},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14177.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15170.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14823.96,"10th_percentile":14823.96,"90th_percentile":14823.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11069.9,"10th_percentile":11069.9,"90th_percentile":11069.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10104.58,"maximum":35194.66,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":26820.71},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18503.08},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30578.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":10609.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21914.91},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10710.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19368.14},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10104.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26674.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10609.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19368.14},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22246.26},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10104.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10811.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23392.48,"maximum":84904.07,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":64702.62},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":44637.08},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73768.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25029.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":44262.59},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":41620.0},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":56584.59},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":48430.32},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":50952.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24094.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24094.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":43942.46},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":70295.85},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":79078.3},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":56022.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84904.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":24562.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":52867.82},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24796.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":46723.97},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23392.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64349.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24562.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":46723.97},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":53667.18},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23392.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25029.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Hmo","methodology":"fee schedule","standard_charge_dollar":12562.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26247.48},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12682.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23197.22},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11964.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31947.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12562.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23197.22},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26644.34},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11964.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12802.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10678.73,"maximum":37342.5,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":28457.5},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19632.27},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32445.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30712.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17070.17,"maximum":61252.6,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":46678.61},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32202.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53219.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18265.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":31932.49},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30026.04},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40822.0},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":34939.24},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":36758.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":18094.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33708.21},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17070.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46423.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17923.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33708.21},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":38717.28},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17070.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18265.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":31070.67,"10th_percentile":31070.67,"90th_percentile":31070.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"1 through 10","median_amount":83513.91,"10th_percentile":83513.91,"90th_percentile":83513.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11664.68,"maximum":41030.92,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":31268.33},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21571.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35649.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12481.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21390.43},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20113.37},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27345.19},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23404.54},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24623.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12014.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12014.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21235.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33971.32},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38215.55},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27073.73},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41030.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12481.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29738.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12481.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12247.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21320.38},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11664.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11839.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12247.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25549.01},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12364.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22579.92},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11664.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31097.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12247.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22579.92},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25935.32},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11664.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12481.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11493.34,"maximum":40389.95,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":30779.86},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21234.43},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35092.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12297.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21056.28},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19799.16},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26918.01},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23038.92},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24238.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11838.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11838.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20903.99},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33440.63},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37618.55},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26650.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40389.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12297.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29274.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12297.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12068.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20987.31},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11493.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11665.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12068.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25149.89},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12182.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22227.19},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11493.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30611.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12068.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22227.19},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25530.16},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11493.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12297.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11993.64,"10th_percentile":11993.64,"90th_percentile":11993.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":23419.93,"10th_percentile":23419.93,"90th_percentile":23419.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2657.85,"10th_percentile":2657.85,"90th_percentile":4022.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12009.66,"10th_percentile":12009.66,"90th_percentile":12009.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7431.53,"maximum":25194.87,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":19200.19},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13245.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21890.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7951.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":13134.71},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12350.53},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16791.2},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14371.46},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15119.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7654.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7654.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13039.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20859.95},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23466.1},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16624.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25194.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7951.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18260.97},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7951.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7803.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13091.69},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7431.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7543.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7803.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15688.27},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7877.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13865.11},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7431.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19095.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7803.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13865.11},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15925.47},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7431.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7951.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7778.36,"10th_percentile":7778.36,"90th_percentile":7778.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7280.1,"10th_percentile":7280.1,"90th_percentile":7280.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7440.24,"10th_percentile":7440.24,"90th_percentile":7440.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2657.85,"10th_percentile":2657.85,"90th_percentile":2657.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5778.78,"10th_percentile":5778.78,"90th_percentile":5778.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5364.92,"maximum":17463.8,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":13308.59},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9181.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15173.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5740.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":9104.31},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":8560.76},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":11638.8},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":9961.56},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":10480.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5525.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5525.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9038.46},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":14459.05},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16265.5},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11523.26},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17463.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5740.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12657.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5740.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5633.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9074.49},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5364.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5445.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5633.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10874.3},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5686.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":9610.59},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5364.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13235.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5633.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":9610.59},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":11038.72},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5364.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5740.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25045.65,"10th_percentile":25045.65,"90th_percentile":25045.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2030.36,"10th_percentile":2030.36,"90th_percentile":2030.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10733.58,"maximum":37547.72,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":28613.89},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19740.17},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32623.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11484.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19574.55},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18405.9},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25023.8},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21417.68},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22532.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11055.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11055.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19432.98},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31087.43},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34971.35},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24775.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37547.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11484.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27214.19},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11484.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11270.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19510.44},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10733.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10894.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11270.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23380.11},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11377.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20663.07},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10733.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28457.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11270.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20663.07},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23733.61},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10733.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11484.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24543.5,"10th_percentile":24543.5,"90th_percentile":24543.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":18374.41,"10th_percentile":18374.41,"90th_percentile":18374.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11002.39,"10th_percentile":11002.39,"90th_percentile":11002.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10733.74,"10th_percentile":10023.63,"90th_percentile":10734.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4082.62,"10th_percentile":4082.62,"90th_percentile":4082.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3730.2,"10th_percentile":3730.2,"90th_percentile":3730.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9340.41,"10th_percentile":9159.11,"90th_percentile":9468.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6544.76,"maximum":21877.54,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":16672.16},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11501.8},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19008.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7002.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11405.3},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10724.37},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14580.36},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12479.22},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13129.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6741.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6741.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11322.81},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18113.38},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20376.39},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14435.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21877.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7002.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15856.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7002.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6872.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11367.95},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6544.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6642.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6872.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13622.64},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6937.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12039.53},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6544.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16581.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6872.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12039.53},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13828.61},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6544.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7002.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6835.89,"10th_percentile":6835.89,"90th_percentile":6835.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":14580.36,"10th_percentile":14580.36,"90th_percentile":14580.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6547.47,"10th_percentile":6547.47,"90th_percentile":6547.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"1 through 10","median_amount":13622.64,"10th_percentile":13622.64,"90th_percentile":13622.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2325.06,"10th_percentile":2325.06,"90th_percentile":2325.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5071.42,"10th_percentile":5071.42,"90th_percentile":5071.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11383.63,"maximum":39979.5,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":30467.07},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21018.64},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34736.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12180.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20842.3},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19597.96},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26644.47},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22804.8},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23992.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11725.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11725.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20691.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33100.8},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37236.27},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26379.96},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39979.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12180.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28976.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":12066.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22001.31},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11383.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30300.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11952.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22001.31},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25270.72},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11383.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12180.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13066.97,"maximum":46276.81,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":35266.05},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24329.36},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40207.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13981.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24125.24},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22684.9},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30841.33},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26396.86},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27771.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13458.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13458.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23950.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38314.62},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43101.48},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30535.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46276.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13981.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33540.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13981.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13720.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24046.23},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13066.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13262.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13720.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28815.51},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13850.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25466.81},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13066.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35073.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13720.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25466.81},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29251.2},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13066.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13981.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":5167.04,"10th_percentile":5167.04,"90th_percentile":5167.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8399.45,"maximum":28815.83,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":21959.6},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15149.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25036.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8987.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15022.4},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14125.53},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19204.4},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16436.9},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17292.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8651.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8651.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14913.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23857.9},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26838.6},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19013.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28815.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8987.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20885.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8987.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8819.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14973.2},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8399.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8525.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8819.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17942.95},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8903.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15857.78},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8399.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21839.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8819.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15857.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18214.25},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8399.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8987.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8786.1,"10th_percentile":8786.1,"90th_percentile":8786.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7980.83,"10th_percentile":7980.83,"90th_percentile":7980.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":5167.04,"10th_percentile":5167.04,"90th_percentile":5167.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6470.37,"maximum":21599.22,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":16460.06},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11355.47},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18766.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6923.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11260.2},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10587.94},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14394.87},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12320.46},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12961.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6664.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6664.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11178.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17882.95},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20117.17},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14251.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21599.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6923.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15654.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6923.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6793.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11223.33},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6470.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6567.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6793.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13449.34},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6858.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11886.37},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16370.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6793.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11886.37},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13652.69},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6923.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36027.32,"maximum":132170.46,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":100722.79},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":69486.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114836.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38549.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":68903.72},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":64789.99},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":88085.43},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":75391.65},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":79317.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37108.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":37108.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":68405.37},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":109429.79},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":123101.46},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":87210.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":132170.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38549.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":95795.73},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38549.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37828.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68678.05},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36027.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36567.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37828.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":82299.51},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38188.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":72735.36},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36027.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100172.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37828.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":72735.36},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":83543.88},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36027.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38549.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis Without Mcc","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28545.46,"maximum":104181.16,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":79393.06},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":54771.72},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90517.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30543.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":54312.2},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":51069.63},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":69431.87},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":59426.21},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":62520.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29401.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29401.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":53919.39},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":86256.2},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":97032.67},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":68742.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":104181.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30543.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":75509.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30543.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29972.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54134.33},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28545.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28973.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29972.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":64871.21},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30258.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":57332.43},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28545.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78959.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29972.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":57332.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":65852.07},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28545.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30543.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant","code_information":[{"code":"652","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24966.1,"maximum":90790.93,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":69188.81},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47732.01},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78883.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26713.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":47331.55},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":44505.74},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":60507.91},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":51788.26},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":54484.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25715.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25715.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":46989.23},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":75169.84},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":84561.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":59907.23},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90790.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":26214.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":56533.43},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26464.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":49963.59},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24966.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68810.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26214.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":49963.59},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":57388.22},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24966.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26713.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39747.21,"maximum":146086.39,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":111327.67},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":76802.79},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":126927.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42529.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":76158.44},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":71611.59},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":97359.75},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":83329.47},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":87668.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40939.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":40939.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":75607.62},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":120951.41},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":136062.54},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":96393.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146086.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42529.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":105881.85},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42529.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41734.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75909.01},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39747.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40343.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41734.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":90964.64},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42132.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":80393.5},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39747.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110719.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41734.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":80393.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":92340.03},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39747.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42529.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21733.18,"maximum":78696.72,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":59972.2},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":41373.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68375.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23254.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":41026.54},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":38577.15},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":52447.68},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":44889.57},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":47226.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22385.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22385.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":40729.82},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":65156.51},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":73296.87},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":51927.02},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78696.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":22819.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":49002.64},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23037.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":43307.97},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21733.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59644.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22819.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":43307.97},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":49743.56},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21733.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23254.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures Without Cc/Mcc","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16602.74,"maximum":59503.98,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":45346.04},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31283.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51700.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17764.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":31020.89},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":29168.86},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39656.62},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33941.8},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35709.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17100.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17100.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30796.53},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49265.98},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55421.05},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":39262.93},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59503.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17764.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":43127.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17764.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17432.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30919.29},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16602.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16851.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17432.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37051.76},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17598.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32745.92},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16602.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45098.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17432.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32745.92},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":37611.98},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16602.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17764.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Mcc","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24622.67,"maximum":89506.17,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":68209.73},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47056.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77767.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26346.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":46661.77},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":43875.95},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":59651.68},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":51055.42},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":53713.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25361.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25361.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":46324.29},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":74106.13},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":83364.62},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":59059.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89506.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26346.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":64873.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26346.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25853.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46508.95},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24622.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24992.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25853.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":55733.44},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26100.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":49256.57},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24622.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67837.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25853.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":49256.57},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":56576.13},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24622.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26346.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14448.96,"maximum":51446.79,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":39205.92},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27047.4},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44699.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15460.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12358.31,"maximum":43625.75,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":33245.76},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22935.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37904.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13223.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19791.32,"maximum":71432.32,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":54436.24},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":37554.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62064.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21176.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37239.43},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":35016.14},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47606.3},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":40745.87},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":42867.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20385.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20385.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":36970.1},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":59141.99},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":66530.93},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":47133.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71432.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":20780.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":44479.27},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20978.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39310.26},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19791.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54138.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20780.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":39310.26},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":45151.79},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19791.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21176.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3591.35,"10th_percentile":3591.35,"90th_percentile":3591.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10629.13,"maximum":37156.95,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":28316.1},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19534.73},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32283.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11373.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19370.84},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18214.35},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24763.37},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21194.78},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22298.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10948.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10948.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19230.74},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30763.89},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34607.39},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24517.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37156.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":11160.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23136.78},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11266.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20448.02},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10629.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28161.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11160.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20448.02},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23486.61},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10629.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11373.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10629.3,"10th_percentile":10629.3,"90th_percentile":10629.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8477.6,"maximum":29108.2,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":22182.41},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15303.21},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25290.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9071.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15174.82},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14268.85},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19399.25},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16603.67},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17468.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8731.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8731.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15065.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24099.97},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27110.91},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19206.67},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29108.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9071.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21097.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9071.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8901.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15125.12},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8477.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8604.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8901.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18125.01},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8986.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16018.67},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8477.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22061.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8901.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16018.67},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18399.06},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8477.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9071.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":45176.96,"10th_percentile":45176.96,"90th_percentile":45176.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8479.98,"10th_percentile":8479.98,"90th_percentile":8479.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3550.96,"10th_percentile":3550.96,"90th_percentile":3550.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23703.59,"maximum":86067.95,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":65589.58},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":45248.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74780.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25362.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":44869.34},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":42190.53},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":57360.26},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":49094.21},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":51650.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24414.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24414.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":44544.83},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":71259.47},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":80162.32},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":56790.83},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86067.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25362.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":62381.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25362.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24888.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44722.39},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23703.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24059.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24888.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":53592.54},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25125.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":47364.47},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23703.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65231.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24888.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":47364.47},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":54402.86},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23703.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25362.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12120.84,"maximum":42737.38,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":32568.76},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22468.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37132.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":12726.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26611.59},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12848.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23519.01},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12120.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32390.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12726.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23519.01},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27013.95},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12120.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12969.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures Without Cc/Mcc","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8564.03,"maximum":29431.5,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":22428.79},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15473.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25571.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":8992.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18326.32},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9077.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16196.59},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8564.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22306.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8992.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16196.59},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18603.41},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8564.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9163.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Mcc","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24152.23,"maximum":87746.3,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":66868.59},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":46131.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76238.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Cc","code_information":[{"code":"666","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13842.51,"maximum":49178.07,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":37477.0},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25854.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42728.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14811.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25637.74},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24107.1},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32774.88},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28051.77},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29512.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14257.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14257.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25452.32},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40716.71},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45803.67},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32449.52},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49178.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14811.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35643.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14811.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14534.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25553.77},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13842.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14050.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14534.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30622.06},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14673.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27063.42},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13842.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37272.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14534.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27063.42},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31085.06},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13842.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14811.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":480.0,"10th_percentile":480.0,"90th_percentile":480.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy Without Cc/Mcc","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9009.66,"maximum":31098.6,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":23699.23},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16349.64},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27020.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9640.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16212.47},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15244.54},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20725.76},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17739.02},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18662.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9279.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9279.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16095.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25747.91},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28964.74},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20520.01},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31098.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9640.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22539.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9640.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9460.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16159.37},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9009.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9144.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9460.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19364.38},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9550.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17114.02},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9009.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23569.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9460.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17114.02},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19657.17},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9009.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9640.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22640.23,"maximum":82089.96,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":62558.08},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":43157.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71323.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24225.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":42795.52},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":40240.52},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":54709.12},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":46825.12},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":49263.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23319.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23319.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":42486.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":67965.92},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":76457.28},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":54166.0},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82089.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24225.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":59497.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24225.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23772.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42655.36},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22640.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22979.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23772.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":51115.53},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23998.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":45175.32},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22640.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62216.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23772.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":45175.32},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":51888.4},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22640.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24225.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12359.81,"maximum":43631.38,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":33250.05},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22938.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37909.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13225.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22746.11},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21388.11},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29078.27},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24887.87},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26183.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12730.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12730.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22581.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36124.35},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40637.57},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28789.6},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43631.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13225.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31623.55},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13225.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12977.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22671.62},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12359.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12545.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12977.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27168.26},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13101.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24010.99},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12359.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33068.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12977.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24010.99},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27579.04},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12359.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13225.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12438.79,"10th_percentile":12438.79,"90th_percentile":12438.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8040.99,"maximum":27474.83,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":20937.68},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14444.49},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23871.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8603.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14323.31},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13468.17},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18310.69},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15671.98},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16488.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8282.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8282.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14219.72},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22747.63},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25589.62},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18128.92},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27474.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8603.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19913.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8603.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8443.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14276.4},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8040.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8161.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8443.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17107.95},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8523.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15119.81},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8040.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20823.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8443.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15119.81},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17366.62},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8040.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8603.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14185.94,"maximum":50462.84,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":38456.08},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26530.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43844.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15178.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26307.52},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24736.9},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33631.12},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28784.62},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30283.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14611.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14611.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26117.25},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41780.42},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47000.28},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33297.25},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50462.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15178.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":36574.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15178.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14895.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26221.36},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14185.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14398.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14895.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31422.05},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15037.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27770.45},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14185.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38246.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14895.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27770.45},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31897.15},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14185.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15178.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8809.01,"maximum":30347.98,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":23127.21},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15955.01},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26367.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9425.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15821.15},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14876.59},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20225.51},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17310.86},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18212.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9073.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9073.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15706.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25126.44},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28265.63},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20024.73},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30347.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9425.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21995.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9425.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9249.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15769.34},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8809.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8941.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9249.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18896.99},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9337.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16700.94},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8809.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23000.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9249.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16700.94},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19182.72},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8809.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9425.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32271.36,"maximum":118119.58,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":90015.08},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":62099.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102628.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34530.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":61578.65},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":57902.25},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":78721.18},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":67376.86},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":70885.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33239.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33239.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":61133.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":97796.44},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":110014.69},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":77939.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":118119.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34530.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":85611.8},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34530.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33884.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61376.97},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32271.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32755.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33884.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":73550.35},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34207.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":65002.95},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32271.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89523.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33884.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":65002.95},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":74662.43},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32271.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34530.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":97741.82,"10th_percentile":97741.82,"90th_percentile":97741.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33678.36,"10th_percentile":33678.36,"90th_percentile":33678.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":9943.94,"10th_percentile":9943.94,"90th_percentile":9943.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18271.05,"maximum":65745.06,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":50102.17},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":34564.51},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57122.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19550.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":34274.52},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":32228.25},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43816.01},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":37501.79},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":39454.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18819.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18819.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":34026.63},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54433.25},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":61233.9},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":43381.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65745.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19550.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":47651.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19550.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19184.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34162.27},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18271.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18545.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19184.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40937.94},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19367.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36180.48},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18271.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49828.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19184.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":36180.48},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":41556.92},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18271.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19550.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13031.65,"maximum":46144.68,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":35165.35},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24259.89},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40092.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13943.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24056.36},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22620.13},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30753.27},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26321.49},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27692.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13422.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13422.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23882.37},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38205.23},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42978.42},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30447.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46144.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13943.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33445.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13943.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13683.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23977.57},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13031.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13227.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13683.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28733.23},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13813.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25394.1},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13031.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34973.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13683.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25394.1},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29167.68},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13031.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13943.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11826.25,"maximum":41635.35,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":31728.94},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21889.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36174.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12654.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21705.54},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20409.66},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27748.02},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23749.32},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24985.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12181.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12181.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21548.55},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34471.76},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38778.5},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27472.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41635.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12654.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30176.86},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12654.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21634.45},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11826.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12003.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25925.38},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12535.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22912.55},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11826.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31555.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12417.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22912.55},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26317.37},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11826.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12654.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12365.96,"10th_percentile":12365.96,"90th_percentile":12365.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":23749.32,"10th_percentile":23749.32,"90th_percentile":23749.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12592.82,"10th_percentile":12592.82,"90th_percentile":12592.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11843.57,"10th_percentile":11843.57,"90th_percentile":11843.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"1 through 10","median_amount":31555.67,"10th_percentile":31555.67,"90th_percentile":31555.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10277.69,"10th_percentile":10277.69,"90th_percentile":10277.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7278.22,"maximum":24621.37,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":18763.14},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12944.32},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21392.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7787.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12835.72},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12069.4},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16408.99},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14044.33},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14775.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7496.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7496.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12742.89},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20385.12},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22931.95},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16246.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24621.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7787.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17845.3},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7787.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7642.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12793.69},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7278.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7387.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7642.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15331.16},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7714.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13549.5},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7278.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18660.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7642.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13549.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15562.97},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7278.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7787.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":2881.08,"10th_percentile":2881.08,"90th_percentile":2881.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":13598.73,"10th_percentile":13598.73,"90th_percentile":13598.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1580.0,"10th_percentile":1580.0,"90th_percentile":1580.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7289.49,"10th_percentile":7289.49,"90th_percentile":7289.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"1 through 10","median_amount":18660.67,"10th_percentile":18660.67,"90th_percentile":18660.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5207.86,"maximum":16876.23,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":12860.83},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":8872.43},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14662.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5572.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":8798.0},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":8272.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":11247.22},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":9626.41},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":10127.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5364.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5364.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":8734.37},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":13972.58},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15718.26},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11135.57},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16876.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5572.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12231.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5572.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5468.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8769.18},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5207.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5285.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5468.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10508.44},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":9287.24},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5207.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12790.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5468.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":9287.24},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":10667.33},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5207.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5572.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":7241.3,"10th_percentile":7241.3,"90th_percentile":7241.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14251.32,"maximum":50707.42,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":38642.47},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26658.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44057.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15248.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26435.03},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24856.79},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33794.12},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28924.13},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30430.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14678.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14678.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26243.84},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41982.92},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47228.08},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33458.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50707.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15248.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":36752.19},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15248.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14963.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26348.45},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14251.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14465.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14963.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31574.35},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15106.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27905.04},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14251.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38431.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14963.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27905.04},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32051.75},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14251.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15248.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8570.79,"maximum":29456.8,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":22448.07},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15486.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25593.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9170.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15356.56},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14439.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19631.58},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16802.52},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17677.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8827.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8827.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15245.49},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24388.59},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27435.6},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19436.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29456.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":8999.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18342.07},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9085.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16210.51},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8570.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22325.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8999.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16210.51},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18619.41},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8570.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9170.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6635.7,"maximum":22217.7,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":16931.39},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11680.63},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19303.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7100.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11582.64},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10891.12},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14807.06},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12673.25},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13333.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6834.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6834.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11498.87},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18395.02},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20693.22},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14660.07},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22217.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7100.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16103.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7100.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6967.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11544.7},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6635.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6735.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6967.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13834.45},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7033.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12226.73},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6635.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16838.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6967.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12226.73},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14043.63},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6635.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7100.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9416.22,"maximum":32619.51,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":24858.27},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17149.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28341.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10075.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17005.36},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15990.09},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21739.38},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18606.57},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19575.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9698.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9698.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16882.37},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27007.14},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30381.3},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21523.57},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32619.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10075.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23642.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10075.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9887.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16949.66},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9416.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9557.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9887.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20311.42},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9981.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17951.0},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9416.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24722.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9887.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17951.0},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20618.53},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9416.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10075.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9652.48,"10th_percentile":9652.48,"90th_percentile":9652.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8715.67,"10th_percentile":8715.67,"90th_percentile":9425.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8075.11,"10th_percentile":8075.11,"90th_percentile":9839.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6779.98,"maximum":22757.47,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":17342.73},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11964.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19772.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7254.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11864.03},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11155.72},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15166.79},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12981.14},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13657.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6983.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6983.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11778.23},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18841.92},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21195.95},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15016.23},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22757.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7254.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16494.37},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7254.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7118.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11825.18},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6779.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6881.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7118.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14170.56},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7186.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12523.77},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6779.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17248.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7118.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12523.77},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14384.82},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6779.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7254.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":26322.76,"10th_percentile":26322.76,"90th_percentile":26322.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6951.13,"10th_percentile":6951.13,"90th_percentile":6951.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7221.08,"10th_percentile":7221.08,"90th_percentile":7221.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6791.4,"10th_percentile":6781.4,"90th_percentile":6791.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2630.31,"10th_percentile":2630.31,"90th_percentile":2630.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10800.47,"maximum":37797.93,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":28804.57},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19871.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32840.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11556.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19704.99},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18528.55},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25190.55},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21560.4},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22683.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11124.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11124.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19562.48},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31294.58},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35204.39},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24940.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37797.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11556.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27395.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11556.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11340.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19640.46},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10800.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10962.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11340.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23535.9},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11448.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20800.76},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28647.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11340.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20800.76},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23891.77},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11556.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6571.07,"maximum":21975.93,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":16747.14},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11553.53},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19093.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7031.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11456.6},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10772.61},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14645.93},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12535.34},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13188.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6768.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6768.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11373.74},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18194.85},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20468.03},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14500.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21975.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7031.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15927.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7031.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6899.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11419.07},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6571.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6669.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6899.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13683.91},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6965.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12093.68},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6571.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16655.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6899.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12093.68},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13890.81},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6571.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7031.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":21975.93,"10th_percentile":21975.93,"90th_percentile":21975.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6578.16,"10th_percentile":6578.16,"90th_percentile":6578.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9292.22,"maximum":32155.65,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":24504.77},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16905.36},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27938.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9942.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16763.53},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15762.71},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21430.24},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18341.98},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19297.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9570.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9570.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16642.29},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26623.09},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29949.26},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21217.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32155.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9942.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23306.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9942.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9756.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16708.63},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9292.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9431.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9756.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20022.59},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9849.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17695.73},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9292.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24370.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9756.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17695.73},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20325.33},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9292.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9942.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5874.43,"maximum":19369.86,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":14761.14},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10183.42},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16829.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6285.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":10097.98},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9495.11},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":12909.1},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11048.8},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11624.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6050.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6050.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10024.95},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16037.16},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18040.78},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12780.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19369.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6285.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14039.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6285.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6168.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10064.91},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5874.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5962.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6168.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12061.17},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6226.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10659.52},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5874.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14680.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6168.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10659.52},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12243.53},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5874.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6285.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5876.15,"10th_percentile":5876.15,"90th_percentile":5876.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8796.24,"maximum":30300.19,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":23090.79},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15929.88},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26326.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9411.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15796.24},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14853.16},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20193.66},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17283.6},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18183.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9060.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9060.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15681.99},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25086.87},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28221.12},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19993.19},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30300.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9411.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21961.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9411.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9236.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15744.5},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8796.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8928.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9236.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18867.23},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9324.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16674.64},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8796.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22964.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9236.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16674.64},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19152.51},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8796.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9411.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13129.34,"maximum":46510.15,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":35443.87},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24452.03},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40410.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14048.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24246.89},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22799.29},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30996.84},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26529.96},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27911.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13523.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13523.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24071.52},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38507.81},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43318.81},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30689.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46510.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14048.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33710.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14048.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13785.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24167.48},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13129.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13326.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13785.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28960.8},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13917.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25595.22},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13129.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35250.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13785.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25595.22},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29398.69},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13129.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14048.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13312.33,"10th_percentile":13312.33,"90th_percentile":13312.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13128.74,"10th_percentile":13128.74,"90th_percentile":13128.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4369.06,"10th_percentile":4369.06,"90th_percentile":4369.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8324.3,"maximum":28534.7,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":21745.36},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15001.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24792.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8907.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14875.84},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13987.72},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19017.04},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16276.54},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17124.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8574.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8574.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14768.25},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23625.14},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26576.76},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18828.25},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28534.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8907.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20681.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8907.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8740.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14827.12},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8324.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8449.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8740.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17767.9},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8823.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15703.07},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8324.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21626.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8740.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15703.07},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18036.55},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8324.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8907.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":17124.07,"10th_percentile":17124.07,"90th_percentile":17124.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8525.31,"10th_percentile":8525.31,"90th_percentile":8525.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5881.2,"maximum":19395.16,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":14780.42},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10196.72},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16851.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6292.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":10111.17},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9507.51},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":12925.97},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11063.24},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11639.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6057.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6057.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10038.05},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16058.11},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18064.34},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12797.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19395.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6292.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14057.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6292.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6175.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10078.06},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5881.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5969.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6175.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12076.92},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6234.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10673.44},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5881.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14699.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6175.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10673.44},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12259.52},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5881.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6292.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"1 through 10","median_amount":12076.92,"10th_percentile":12076.92,"90th_percentile":12076.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15728.76,"maximum":56234.43,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":42854.43},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29564.43},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48859.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16829.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":29316.4},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27566.13},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37477.62},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":32076.81},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33747.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16200.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16200.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29104.37},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46558.98},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":52375.86},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":37105.57},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56234.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16829.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":40758.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16829.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16515.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29220.38},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15728.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15964.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16515.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35015.89},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16672.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30946.64},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15728.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42620.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16515.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30946.64},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35545.33},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15728.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16829.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures Without Cc/Mcc","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12226.05,"maximum":43130.96,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":32868.7},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22675.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37474.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13081.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22485.24},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21142.81},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28744.77},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24602.43},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25883.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12592.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12592.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22322.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35710.04},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40171.49},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28459.41},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43130.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":12837.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26856.66},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12959.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23735.61},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12226.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32689.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12837.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23735.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27262.73},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12226.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13081.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures With Cc/Mcc","code_information":[{"code":"709","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18184.63,"maximum":65421.76,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":49855.79},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":34394.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56841.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":19093.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40736.63},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19275.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36002.56},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18184.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49583.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19093.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":36002.56},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":41352.57},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18184.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19457.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures Without Cc/Mcc","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11226.56,"maximum":39391.94,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":30019.31},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20709.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34225.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":11787.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24528.45},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11900.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21677.97},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11226.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29855.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11787.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21677.97},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24899.32},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11226.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12012.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16356.25,"maximum":58581.87,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":44643.33},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30798.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50898.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17501.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30540.17},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28716.85},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39042.08},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33415.82},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35155.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16846.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16846.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30319.29},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48502.53},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54562.22},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38654.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58581.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17501.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":42459.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17501.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17174.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30440.15},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16356.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16601.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17174.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36477.59},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17337.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32238.47},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16356.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44399.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17174.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32238.47},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":37029.13},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16356.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17501.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8960.81,"maximum":30915.87,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":23559.97},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16253.57},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26861.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9588.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16117.2},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15154.97},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20603.98},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17634.79},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18553.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9229.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9229.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16000.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25596.62},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28794.54},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20399.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30915.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9588.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22407.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9588.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9408.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16064.42},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8960.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9095.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9408.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19250.6},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9498.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17013.46},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8960.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23431.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9408.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17013.46},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19541.67},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8960.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9588.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11994.59,"maximum":42265.08,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":32208.84},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22220.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36722.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":12594.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26317.5},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12714.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23259.1},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11994.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32032.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12594.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23259.1},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26715.42},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11994.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12834.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8642.93,"maximum":29726.69,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":22653.74},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15628.37},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25828.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9247.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15497.25},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14572.03},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19811.45},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16956.47},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17839.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8902.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8902.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15385.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24612.04},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27686.96},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19614.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29726.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":9075.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18510.13},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9161.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16359.04},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8642.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22530.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9075.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16359.04},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18790.0},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8642.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9247.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18735.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","code_information":[{"code":"716","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11751.11,"maximum":41354.22,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":31514.7},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21741.38},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35930.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12573.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21558.98},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20271.85},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27560.66},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23588.96},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24817.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11787.18,"maximum":41489.17,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":31617.54},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21812.32},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36047.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12612.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21629.32},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20338.0},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27650.59},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23665.93},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24898.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12612.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14536.89,"maximum":51775.71,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":39456.58},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27220.33},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44985.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15554.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26991.96},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25380.47},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34506.09},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29533.5},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":31071.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14973.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14973.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26796.74},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42867.41},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48223.07},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":34163.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51775.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":15263.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32239.55},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15409.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28492.94},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14536.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39241.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15263.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":28492.94},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32727.01},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14536.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15554.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8871.39,"maximum":30581.32,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":23305.03},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16077.68},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26570.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9492.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15942.8},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14990.97},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20381.02},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17443.96},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18352.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9137.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9137.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15827.49},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25319.63},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28482.96},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20178.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30581.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9492.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22165.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9492.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9314.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15890.58},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8871.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9004.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9314.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19042.29},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9403.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16829.35},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8871.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23177.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9314.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16829.35},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19330.21},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8871.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9492.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":30581.32,"10th_percentile":30581.32,"90th_percentile":30581.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14903.62,"maximum":53147.63,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":40502.07},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27941.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46177.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15946.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":27707.17},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26052.98},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35420.41},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30316.06},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":31894.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15350.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15350.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27506.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44003.28},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49500.85},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":35068.78},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53147.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15946.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":38520.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15946.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15648.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27616.42},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14903.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15127.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15648.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33093.81},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15797.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29247.93},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14903.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40280.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15648.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29247.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":33594.19},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14903.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15946.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10789.95,"maximum":37758.57,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":28774.57},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19851.02},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32806.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11545.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19684.47},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18509.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25164.32},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21537.95},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22659.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11113.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11113.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19542.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31262.0},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35167.73},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24914.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37758.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11545.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27367.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11545.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11329.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19620.0},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10789.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10951.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11329.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23511.4},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11437.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20779.1},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10789.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28617.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11329.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20779.1},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23866.89},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10789.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11545.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14296.41,"maximum":50876.1,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":38771.01},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26747.37},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44203.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15297.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26522.96},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24939.48},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33906.54},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29020.35},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30531.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14725.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14725.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26331.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42122.58},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47385.18},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33569.94},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50876.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15297.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":36874.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15297.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15011.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26436.1},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14296.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14510.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15011.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31679.38},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15154.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27997.87},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14296.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38559.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15011.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27997.87},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32158.37},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14296.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15297.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9283.96,"maximum":32124.73,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":24481.2},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16889.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27911.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9933.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16747.41},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15747.55},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21409.63},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18324.34},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19278.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9562.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9562.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16626.29},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26597.49},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29920.46},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21197.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32124.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":9748.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20003.33},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9841.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17678.71},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9283.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24347.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9748.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17678.71},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20305.78},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9283.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9933.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System Without Cc/Mcc","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5624.19,"maximum":18433.69,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":14047.72},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9691.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16016.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6017.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":9609.94},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9036.2},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":12285.2},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10514.81},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11062.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5792.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5792.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9540.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":15262.07},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17168.85},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12163.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18433.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":5905.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11478.24},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5961.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10144.33},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5624.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13971.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5905.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10144.33},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":11651.79},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5624.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6017.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy With Mcc","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9490.62,"maximum":32897.83,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":25070.36},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17295.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28583.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10154.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17150.45},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16126.53},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21924.87},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18765.33},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19742.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9775.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9775.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17026.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27237.58},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30640.52},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21707.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32897.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10154.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23844.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10154.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9965.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.28},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9490.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9632.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9965.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20484.73},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10060.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18104.16},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9490.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24933.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9965.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18104.16},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20794.45},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9490.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10154.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6122.43,"maximum":20297.59,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":15468.13},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10671.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17635.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6551.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":10581.63},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9949.88},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":13527.39},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11577.99},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12180.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6306.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6306.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10505.1},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16805.27},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18904.85},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13393.1},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20297.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6551.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14711.47},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6551.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6428.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10546.98},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6122.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6214.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6428.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12638.84},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6489.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11170.06},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6122.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15383.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6428.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11170.06},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12829.94},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6122.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6551.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11840.53,"maximum":41688.77,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":31769.65},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21917.26},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36221.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":12432.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25958.64},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12550.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22941.95},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11840.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31596.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12432.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22941.95},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26351.13},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11840.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12669.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6792.76,"maximum":22805.27,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":17379.15},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11989.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19814.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7268.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8652.7,"maximum":29763.23,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":22681.59},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15647.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25859.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":9085.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18532.88},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9171.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16379.15},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8652.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22557.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9085.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16379.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18813.1},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8652.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9258.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5746.68,"maximum":18891.94,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":14396.93},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9932.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16414.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6148.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":9848.83},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9260.83},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":12590.59},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10776.19},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11337.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5919.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5919.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9777.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":15641.47},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17595.65},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12465.6},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18891.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":6034.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11763.58},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6091.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10396.51},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5746.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14318.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6034.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10396.51},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":11941.44},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5746.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6148.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16703.44,"maximum":59880.69,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":45633.12},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31481.4},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52027.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":17538.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37286.33},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17705.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32953.23},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16703.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45383.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17538.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32953.23},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":37850.1},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16703.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10807.98,"maximum":37826.04,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":28825.99},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19886.49},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32865.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11564.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27558.75,"maximum":100489.92,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":76580.09},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":52831.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87310.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":28936.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":62572.77},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29212.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":55301.09},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27558.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76161.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28936.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":55301.09},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":63518.87},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27558.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29487.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16181.91,"maximum":57929.65,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":44146.29},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30455.67},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50332.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":16991.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36071.46},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17152.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31879.54},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16181.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43905.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16991.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31879.54},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":36616.86},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16181.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17314.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11732.32,"maximum":41283.94,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":31461.14},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21704.43},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35869.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12553.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21522.34},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20237.4},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27513.82},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23548.87},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24775.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12084.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12084.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21366.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34180.81},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38451.2},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27240.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41283.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12553.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29922.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12553.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12318.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21451.85},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11732.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11908.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12318.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25706.56},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12436.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22719.16},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11732.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31289.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12318.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22719.16},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26095.25},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11732.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12553.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27621.12,"maximum":100723.26,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":76757.91},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":52953.78},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87513.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29554.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":52509.52},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":49374.57},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":67127.34},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":57453.78},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":60445.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28449.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":28449.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":52129.74},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":83393.25},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":93812.04},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":66460.94},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100723.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29554.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":73003.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29554.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29002.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52337.54},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27621.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28035.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29002.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":62718.06},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29278.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":55429.5},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27621.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76338.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29002.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":55429.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":63666.36},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27621.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29554.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14295.66,"maximum":50873.28,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":38768.87},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26745.89},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44201.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15296.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26521.5},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24938.1},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33904.67},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29018.75},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30529.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14724.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14724.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26329.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42120.25},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47382.57},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33568.08},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50873.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15296.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":36872.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15296.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15010.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26434.64},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14295.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14510.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15010.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31677.63},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15153.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27996.32},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14295.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38557.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15010.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27996.32},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32156.59},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14295.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15296.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11413.68,"maximum":40091.95,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":30552.77},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21077.76},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34833.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12212.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20900.92},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19653.08},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26719.41},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22868.94},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24059.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11756.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11756.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20749.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33193.9},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37341.0},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26454.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40091.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12212.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29058.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12212.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11984.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20832.47},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11413.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11584.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11984.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24964.34},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12098.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22063.19},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11413.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30385.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11984.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22063.19},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25341.8},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11413.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12212.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14485.03,"maximum":51581.73,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":39308.76},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27118.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44816.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15498.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26890.83},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25285.38},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34376.81},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29422.85},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30954.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14919.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14919.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26696.34},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42706.8},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48042.4},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":34035.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51581.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15498.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":37385.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15498.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15209.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26802.76},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14485.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14702.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15209.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32118.76},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15354.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28386.19},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14485.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39094.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15209.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":28386.19},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32604.4},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14485.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15498.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":28166.17,"10th_percentile":28166.17,"90th_percentile":28166.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10020.42,"maximum":34879.8,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":26580.76},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18337.55},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30305.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10721.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18183.7},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17098.09},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23245.76},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19895.87},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20931.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10321.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10321.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18052.19},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28878.53},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32486.49},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":23014.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34879.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10721.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25280.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10721.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10521.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18124.15},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10020.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10170.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10521.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21718.85},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10621.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19194.87},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10020.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26435.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10521.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19194.87},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22047.24},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10020.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10721.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":18395.87,"10th_percentile":18395.87,"90th_percentile":18395.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16095.48,"maximum":57606.35,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":43899.92},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30285.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50051.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17222.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30031.61},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28238.65},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38391.94},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":32859.37},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":34570.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16578.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16578.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29814.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":47694.85},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":53653.63},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38010.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57606.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17222.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":41752.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17222.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16900.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29933.25},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16095.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16336.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16900.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35870.15},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17061.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31701.63},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16095.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43660.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16900.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31701.63},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":36412.51},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16095.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17222.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9244.88,"maximum":31978.54,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":24369.8},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16812.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27784.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9892.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16671.2},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15675.89},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21312.2},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18240.95},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19190.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9522.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9522.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16550.63},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26476.45},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29784.3},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21100.63},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31978.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":9707.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19912.3},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9799.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17598.26},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9244.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24236.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9707.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17598.26},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20213.38},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9244.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9892.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13750.83,"maximum":48835.09,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":37215.63},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25674.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42430.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14713.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25458.94},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23938.98},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32546.31},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27856.14},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29306.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14163.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14163.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25274.81},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40432.74},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45484.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32223.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48835.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":14438.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30408.49},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14575.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26874.67},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13750.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37012.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14438.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26874.67},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30868.27},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13750.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14713.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7157.23,"maximum":24168.75,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":18418.21},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12706.37},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20999.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7658.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12599.76},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11847.53},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16107.34},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13786.15},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14504.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7371.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7371.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12508.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20010.38},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22510.38},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15947.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24168.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":7515.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15049.32},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7586.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13300.42},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7157.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18317.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7515.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13300.42},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15276.87},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7157.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7658.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11122.11,"maximum":39001.16,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":29721.52},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20504.29},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33886.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":11678.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24285.13},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11789.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21462.92},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11122.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29559.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11678.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21462.92},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24652.32},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11122.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11900.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19991.97,"maximum":72182.94,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":55008.26},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":37949.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62716.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21391.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37630.75},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":35384.1},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":48106.55},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":41174.03},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":43317.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21391.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34731.0,"maximum":127320.97,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":97027.15},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":66937.14},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110622.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37162.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":66375.56},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":62412.77},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":84853.47},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":72625.44},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":76407.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35772.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":35772.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":65895.5},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":105414.68},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":118584.72},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":84011.1},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":127320.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37162.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":92280.87},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37162.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36467.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66158.17},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34731.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35251.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36467.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":79279.84},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36814.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":70066.61},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34731.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96497.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36467.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":70066.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":80478.55},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34731.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37162.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21809.08,"maximum":78980.66,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":60188.59},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":41522.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68622.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23335.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":41174.57},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":38716.34},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":52636.92},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":45051.54},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":47397.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22463.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22463.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":40876.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":65391.59},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":73561.33},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":52114.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78980.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23335.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":57244.33},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23335.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22899.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41039.72},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21809.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22136.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22899.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":49179.45},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23117.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":43464.23},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21809.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59859.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22899.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":43464.23},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":49923.04},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21809.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23335.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures Without Cc/Mcc","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15041.89,"maximum":53664.91,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":40896.27},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28213.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46626.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":15793.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33415.91},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15944.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29532.59},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15041.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40672.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15793.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29532.59},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":33921.15},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15041.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16094.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30636.86,"maximum":112005.0,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":85355.36},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":58885.0},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97315.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32781.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":58390.97},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":54904.88},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":74646.1},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":63889.03},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":67215.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32781.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14666.14,"maximum":52259.26,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":39825.07},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27474.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45405.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15692.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":27244.04},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25617.5},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34828.35},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29809.32},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":31361.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15692.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10886.89,"maximum":38121.23,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":29050.94},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20041.68},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33121.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11648.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19873.54},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18687.04},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25406.02},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21744.82},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22877.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11648.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8806.76,"maximum":30339.55,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":23120.78},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15950.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26360.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9423.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15816.76},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14872.46},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20219.89},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17306.05},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18207.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9070.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9070.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15702.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25119.46},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28257.77},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20019.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30339.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9423.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21989.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9423.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9247.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15764.95},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8806.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8938.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9247.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18891.74},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9335.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16696.3},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8806.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22994.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9247.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16696.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19177.38},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8806.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9423.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2239.66,"10th_percentile":2239.66,"90th_percentile":2239.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6362.9,"maximum":21197.2,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":16153.7},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11144.12},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18417.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6808.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11050.62},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10390.87},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14126.94},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12091.14},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12720.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6553.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6553.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10970.7},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17550.1},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19742.74},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13986.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21197.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6808.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15363.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6808.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6681.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11014.43},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6362.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6458.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6681.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13199.01},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6744.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11665.13},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6362.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16065.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6681.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11665.13},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13398.58},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6362.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6808.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":11201.91,"10th_percentile":11201.91,"90th_percentile":11201.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":10862.81,"10th_percentile":10862.81,"90th_percentile":10862.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":11219.0,"10th_percentile":11219.0,"90th_percentile":11219.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1896.57,"10th_percentile":1896.57,"90th_percentile":1896.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"1 through 10","median_amount":10011.81,"10th_percentile":10011.81,"90th_percentile":10011.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2239.66,"10th_percentile":2239.66,"90th_percentile":2239.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2239.66,"10th_percentile":2239.66,"90th_percentile":2239.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5763.21,"maximum":18953.78,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":14444.06},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9964.68},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16468.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6166.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":9881.08},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9291.15},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":12631.81},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10811.47},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11374.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5936.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5936.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9809.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":15692.68},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17653.25},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12506.41},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18953.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6166.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13737.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6166.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6051.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9848.71},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5763.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5849.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6051.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11802.09},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6109.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10430.55},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5763.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14365.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6051.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10430.55},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":11980.53},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5763.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6166.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":11971.0,"10th_percentile":9964.68,"90th_percentile":14127.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":9611.47,"10th_percentile":8079.45,"90th_percentile":10509.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":13224.0,"10th_percentile":13224.0,"90th_percentile":13224.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"1 through 10","median_amount":10011.81,"10th_percentile":10011.81,"90th_percentile":10011.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1951.81,"10th_percentile":1951.81,"90th_percentile":1951.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1933.4,"10th_percentile":1933.4,"90th_percentile":2239.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"1 through 10","median_amount":11292.0,"10th_percentile":11292.0,"90th_percentile":11292.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2239.66,"10th_percentile":1933.4,"90th_percentile":2239.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17288.85,"maximum":62070.69,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":47302.05},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32632.76},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53930.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18499.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":32358.98},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30427.07},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41367.21},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":35405.88},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":37249.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17807.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17807.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":32124.95},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":51391.08},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":57811.65},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":40956.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62070.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18499.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":24049.0,"10th_percentile":24049.0,"90th_percentile":24049.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10209.79,"maximum":35588.25,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":27120.64},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18710.0},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30920.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10924.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18553.03},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17445.37},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23717.9},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20299.97},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21357.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10516.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10516.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18418.85},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29465.09},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33146.33},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":23482.45},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35588.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":10720.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22159.98},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10822.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19584.74},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10209.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26972.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10720.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19584.74},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22495.04},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10209.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10924.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":20299.97,"10th_percentile":20299.97,"90th_percentile":20299.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10465.67,"10th_percentile":10465.67,"90th_percentile":10465.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10211.62,"10th_percentile":10211.62,"90th_percentile":10211.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8561.77,"maximum":29423.07,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":22422.36},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15468.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25564.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9161.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15338.97},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14423.19},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19609.1},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16783.28},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17657.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8818.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8818.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15228.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24360.66},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27404.17},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19414.43},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29423.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9161.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21325.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9161.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8989.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15288.73},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8561.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8690.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8989.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18321.07},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9075.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16191.95},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8561.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22299.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8989.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16191.95},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18598.08},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8561.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9161.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11249.86,"maximum":39479.09,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":30085.72},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20755.55},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34301.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12037.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20581.42},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19352.66},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26310.96},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22519.35},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23691.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11587.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11587.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20432.57},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32686.49},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36770.19},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26049.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39479.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12037.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28614.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12037.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11812.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20514.01},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11249.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11418.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11812.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24582.72},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11924.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21725.93},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11249.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29921.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11812.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21725.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24954.41},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11249.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12037.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11739.66,"10th_percentile":11739.66,"90th_percentile":11739.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":26110.94,"10th_percentile":26110.94,"90th_percentile":26110.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4339.2,"10th_percentile":3317.79,"90th_percentile":9619.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":5307.03,"10th_percentile":5307.03,"90th_percentile":5307.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11520.22,"10th_percentile":11520.22,"90th_percentile":11755.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7596.85,"maximum":25813.36,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":19671.52},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13571.0},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22427.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8128.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":13457.14},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12653.71},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17203.4},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14724.26},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15490.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7824.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7824.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13359.81},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21372.02},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24042.15},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17032.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25813.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8128.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18709.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8128.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7976.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13413.07},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7596.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7710.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7976.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16073.38},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8052.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14205.47},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7596.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19564.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7976.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14205.47},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16316.41},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7596.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8128.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":17203.4,"10th_percentile":17203.4,"90th_percentile":21372.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7601.02,"10th_percentile":7599.22,"90th_percentile":7602.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2419.01,"10th_percentile":2419.01,"90th_percentile":4339.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2419.01,"10th_percentile":2419.01,"90th_percentile":3317.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7780.63,"10th_percentile":7780.63,"90th_percentile":7939.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12159.17,"maximum":42880.76,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":32678.03},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22543.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37256.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13010.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22354.8},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21020.16},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28578.02},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24459.71},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25733.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12523.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12523.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22193.12},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35502.88},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39938.46},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28294.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42880.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13010.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31079.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13010.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12767.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22281.58},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12159.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12341.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12767.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26700.86},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12888.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23597.92},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12159.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32499.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12767.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23597.92},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27104.58},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12159.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13010.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":108031.48,"10th_percentile":108031.48,"90th_percentile":108031.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4451.64,"10th_percentile":4451.64,"90th_percentile":4451.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16678.64,"maximum":59787.92,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":45562.42},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31432.63},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51946.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17846.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":31168.92},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":29308.05},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39845.85},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":34103.76},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35879.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17179.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17179.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30943.49},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49501.07},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55685.51},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":39450.29},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59787.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17846.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":43333.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17846.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17512.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31066.83},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16678.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16928.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17512.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37228.56},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17679.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32902.18},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16678.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45313.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17512.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32902.18},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":37791.46},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16678.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17846.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":797.29,"10th_percentile":797.29,"90th_percentile":797.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8316.78,"maximum":28506.58,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":21723.94},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14986.92},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24767.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8898.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14861.18},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13973.93},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18998.3},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16260.5},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17107.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8566.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8566.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14753.7},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23601.86},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26550.58},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18809.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28506.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8898.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20661.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8898.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8732.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14812.51},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8316.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8441.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8732.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17750.39},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8815.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15687.59},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8316.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21605.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8732.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15687.59},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18018.78},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8316.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8898.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5446.08,"maximum":17767.42,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":13539.97},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9340.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15437.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5827.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":9262.59},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":8709.59},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":11841.15},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10134.75},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":10662.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5609.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5609.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9195.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":14710.43},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16548.29},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11723.6},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17767.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5827.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12877.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5827.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5718.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9232.26},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5446.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5527.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5718.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11063.36},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5772.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":9777.67},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5446.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13466.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5718.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":9777.67},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":11230.64},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5446.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5827.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2225.44,"10th_percentile":2225.44,"90th_percentile":2225.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Mcc","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17842.7,"maximum":64142.62,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":48881.0},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33722.05},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55730.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19091.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":33439.13},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31442.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42748.06},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":36587.74},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":38492.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":18913.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35298.63},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17842.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48614.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18734.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":35298.63},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":40544.03},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17842.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19091.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10066.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7659.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18745.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9466.57,"maximum":32807.87,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":25001.81},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17248.26},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28505.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10129.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8214.58,"maximum":28124.25,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":21432.57},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14785.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24435.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":8625.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17512.32},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8707.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15477.19},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8214.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21315.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8625.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15477.19},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17777.11},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8214.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8789.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7889.18,"maximum":26906.95,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":20504.91},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14145.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23378.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":8283.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16754.34},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8362.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14807.29},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7889.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20392.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8283.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14807.29},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17007.67},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7889.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8441.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35151.08,"maximum":128892.48,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":98224.76},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":67763.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111988.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17722.46,"maximum":63692.81,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":48538.21},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33485.57},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55339.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18963.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10837.29,"maximum":37935.68,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":28909.55},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19944.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32960.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":11379.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23621.68},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11487.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20876.57},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10837.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28751.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11379.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20876.57},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23978.84},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10837.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11595.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35849.97,"maximum":131506.99,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":100217.19},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":69137.88},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114259.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38359.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":68557.84},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":64464.76},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":87643.26},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":75013.2},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":78919.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38359.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14445.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24443.81,"maximum":88837.08,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":67699.84},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":46704.8},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77186.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12006.61,"maximum":42310.07,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":32243.12},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22243.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36761.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12847.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10414.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6547.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":10665.2,"10th_percentile":10665.2,"90th_percentile":10665.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2456.51,"10th_percentile":2456.51,"90th_percentile":2456.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4626.2,"maximum":14700.29,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":11202.61},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":7728.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12772.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4950.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":7663.62},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":7206.08},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":9797.05},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":8385.22},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":8821.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4764.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":4764.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":7608.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":12171.02},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":13691.61},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":9699.8},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14700.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4950.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":10654.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4950.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4857.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7638.52},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4626.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4695.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4857.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9153.53},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4903.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":8089.79},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4626.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11141.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4857.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":8089.79},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":9291.93},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4626.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4950.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1595.13,"10th_percentile":1595.13,"90th_percentile":1595.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41952.84,"maximum":154337.56,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":117615.62},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":81140.72},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":134096.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44889.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":80459.97},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":75656.31},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":102858.77},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":88036.04},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":92620.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43211.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":43211.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":79878.05},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":127782.91},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":143747.54},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":101837.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":154337.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44889.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":111862.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44889.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44050.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80196.46},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41952.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42582.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44050.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":96102.46},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44470.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":84934.24},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41952.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116973.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44050.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":84934.24},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":97555.52},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41952.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44889.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16371.28,"maximum":58638.1,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":44686.18},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30828.12},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50947.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17517.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30569.48},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28744.41},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39079.55},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33447.89},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35189.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16862.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16862.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30348.39},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48549.08},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54614.59},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38691.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58638.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17517.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":42500.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17517.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17189.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30469.37},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16371.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16616.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17189.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36512.6},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17353.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32269.41},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16371.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44442.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17189.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32269.41},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":37064.67},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16371.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17517.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9861.1,"maximum":34283.8,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":26126.57},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18024.21},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29787.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10551.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16383.31,"maximum":58683.08,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":44720.46},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30851.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50986.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17530.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30592.93},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28766.46},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39109.53},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33473.55},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35216.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16874.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16874.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30371.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48586.32},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54656.48},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38721.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58683.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":17202.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36540.6},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17366.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32294.17},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16383.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44476.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17202.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32294.17},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":37093.1},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16383.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17530.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11547.45,"maximum":40592.36,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":30934.11},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21340.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35268.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12355.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21161.8},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19898.39},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27052.91},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23154.38},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24360.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11893.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11893.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21008.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33608.22},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37807.08},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26784.35},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40592.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":12124.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25275.93},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12240.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22338.58},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11547.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30765.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12124.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22338.58},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25658.1},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11547.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12355.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25006.68,"maximum":90942.74,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":69304.5},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47811.82},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79015.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":26257.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":56627.96},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26507.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":50047.14},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25006.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68926.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26257.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":50047.14},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":57484.17},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25006.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26757.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12956.5,"maximum":45863.55,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":34951.11},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24112.09},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39848.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13863.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23909.8},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22482.32},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30565.91},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26161.13},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27523.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13345.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13345.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23736.87},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37972.47},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42716.58},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30262.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45863.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13863.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33241.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13863.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13604.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23831.49},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12956.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13150.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13604.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28558.18},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13733.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25239.39},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12956.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34760.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13604.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25239.39},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28989.98},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12956.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13863.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":26161.13,"10th_percentile":26161.13,"90th_percentile":26161.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8289.73,"maximum":28405.38,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":21646.81},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14933.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24680.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8870.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14808.42},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13924.32},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18930.85},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16202.77},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17046.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8538.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8538.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14701.32},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23518.07},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26456.31},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18742.92},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28405.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8870.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20587.91},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8870.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8704.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14759.92},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8289.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8414.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8704.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17687.38},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8787.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15631.9},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8289.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21528.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8704.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15631.9},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17954.81},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8289.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8870.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15687.42,"maximum":56079.81,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":42736.6},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29483.14},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48724.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16785.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":29235.79},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27490.34},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37374.57},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31988.61},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33654.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16158.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16158.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29024.34},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46430.96},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":52231.84},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":37003.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56079.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16785.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":40646.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16785.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16471.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29140.04},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15687.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15922.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16471.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34919.61},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16628.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30861.55},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15687.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42503.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16471.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30861.55},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35447.6},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15687.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16785.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15685.99,"10th_percentile":15685.99,"90th_percentile":15685.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9845.32,"maximum":34224.77,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":26081.58},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17993.17},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29736.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10534.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17842.21},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16776.99},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22809.21},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19522.23},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20538.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10140.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10140.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17713.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28336.2},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31876.4},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":22582.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34224.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10534.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":24805.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10534.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10337.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17783.78},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9845.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9993.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10337.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21310.98},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10436.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18834.4},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9845.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25939.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10337.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18834.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21633.2},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9845.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10534.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7096.36,"maximum":23941.03,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":18244.68},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12586.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20801.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7593.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12481.05},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11735.9},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15955.58},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13656.26},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14367.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7309.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7309.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12390.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19821.84},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22298.29},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15797.18},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23941.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7593.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17352.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7593.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7451.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12440.17},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7096.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7202.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7451.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14907.53},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7522.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13175.1},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7096.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18145.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7451.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13175.1},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15132.93},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7096.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7593.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","code_information":[{"code":"847","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10527.68,"maximum":36777.43,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":28026.88},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19335.2},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31954.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7079.83,"maximum":23879.18,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":18197.55},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12554.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20747.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":7433.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14869.02},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7504.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13141.07},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7079.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18098.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7433.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13141.07},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15093.84},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7079.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7575.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Radiotherapy","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21058.34,"maximum":76172.17,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":58048.33},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":40046.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66182.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":22111.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":47430.66},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22321.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41918.67},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21058.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57731.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22111.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":41918.67},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":48147.82},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21058.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22532.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Other Procedures","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":65772.15,"maximum":243444.52,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":185521.13},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":127987.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":211516.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70376.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37809.86,"maximum":138838.86,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":105804.57},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":72992.51},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":120630.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40456.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":72380.12},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":68058.85},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":92529.61},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":79195.39},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":83319.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40456.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":130954.23,"10th_percentile":130954.23,"90th_percentile":130954.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38747.44,"10th_percentile":38747.44,"90th_percentile":38747.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36788.98,"10th_percentile":32639.06,"90th_percentile":37045.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39499.81,"10th_percentile":27746.15,"90th_percentile":61456.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15712.22,"maximum":56172.59,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":42807.29},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29531.92},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48805.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16812.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":29284.15},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27535.82},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37436.4},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":32041.53},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33709.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16183.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16183.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29072.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46507.78},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":52318.25},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":37064.76},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56172.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16812.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":40713.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16812.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16497.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29188.24},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15712.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15947.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16497.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34977.38},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16654.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30912.61},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15712.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42573.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16497.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30912.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35506.24},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15712.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16812.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":32278.22,"10th_percentile":32278.22,"90th_percentile":32278.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":37064.76,"10th_percentile":37064.76,"90th_percentile":37064.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2595.98,"10th_percentile":2595.98,"90th_percentile":2595.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16416.7,"10th_percentile":16416.7,"90th_percentile":16416.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11948.0,"maximum":42090.78,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":32076.01},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22128.62},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36570.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12784.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21942.96},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20632.91},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28051.54},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24009.1},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25259.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12784.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16789.86,"maximum":60203.99,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":45879.5},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31651.37},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52308.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17965.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":31385.82},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":29512.01},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40123.14},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":34341.09},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":36129.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17965.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17629.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31283.03},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16789.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17041.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17629.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37487.64},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17797.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33131.15},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16789.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45628.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17629.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33131.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":38054.46},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16789.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17965.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17029.01,"10th_percentile":17029.01,"90th_percentile":17029.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"1 through 10","median_amount":37487.64,"10th_percentile":37487.64,"90th_percentile":37487.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11164.19,"maximum":39158.6,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":29841.49},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20587.06},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34022.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11945.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20414.34},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19195.55},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26097.37},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22336.54},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23499.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11499.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11499.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20266.7},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32421.14},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36471.69},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25838.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39158.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11945.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28381.73},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11945.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11722.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20347.48},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11164.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11331.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11722.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24383.16},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11834.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21549.56},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11164.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29678.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11722.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21549.56},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24751.83},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11164.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11945.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14401.62,"maximum":51269.68,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":39070.95},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26954.29},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44545.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15409.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26728.15},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25132.41},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34168.84},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29244.85},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30767.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14833.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14833.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26534.84},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42448.44},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47751.76},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33829.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51269.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15409.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":37159.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15409.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15121.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26640.61},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14401.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14617.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15121.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31924.45},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15265.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28214.46},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14401.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38857.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15121.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":28214.46},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32407.15},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14401.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15409.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15049.58,"10th_percentile":15049.58,"90th_percentile":15049.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":30767.64,"10th_percentile":30767.64,"90th_percentile":30767.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14416.02,"10th_percentile":14416.02,"90th_percentile":14416.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6328.78,"10th_percentile":6328.78,"90th_percentile":6328.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8195.79,"maximum":28053.96,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":21379.01},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14748.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24374.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8769.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14625.22},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13752.06},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18696.65},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16002.32},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16835.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8441.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8441.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14519.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23227.12},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26129.01},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18511.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28053.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8769.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20333.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8769.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8605.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14577.32},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8195.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8318.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8605.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17468.56},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8687.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15438.51},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8195.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21262.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8605.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15438.51},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17732.68},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8195.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8769.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":16002.32,"10th_percentile":16002.32,"90th_percentile":16002.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7367.65,"maximum":24955.91,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":19018.08},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13120.21},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21682.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7883.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":13010.13},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12233.39},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16631.95},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14235.16},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14976.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7588.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7588.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12916.04},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20662.11},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23243.54},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16466.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24955.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7883.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18087.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7883.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7736.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12967.52},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7367.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7478.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7736.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15539.47},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7809.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13733.61},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7367.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18914.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7736.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13733.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15774.43},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7367.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7883.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11956.26,"maximum":42121.71,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":32099.58},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22144.87},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36597.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12793.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21959.08},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20648.07},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28072.15},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24026.74},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25277.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12314.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12314.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21800.27},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34874.43},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39231.49},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27793.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42121.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12793.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30529.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12793.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12554.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21887.17},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11956.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12135.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12554.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26228.22},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12673.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23180.2},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11956.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31924.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12554.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23180.2},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26624.79},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11956.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12793.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7231.63,"maximum":24447.06,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":18630.31},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12852.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21240.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":7593.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15222.63},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7665.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13453.58},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7231.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18528.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7593.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13453.58},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15452.79},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7231.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7737.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16426.89,"maximum":58846.13,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":44844.72},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30937.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51128.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8445.29,"maximum":28987.31,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":22090.29},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15239.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25185.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9036.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15111.8},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14209.59},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19318.69},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16534.72},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17395.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8698.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8698.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15002.51},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23999.88},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26998.32},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19126.91},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28987.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9036.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21009.69},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9036.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8867.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15062.31},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8445.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8571.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8867.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18049.74},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8952.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15952.15},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8445.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21969.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8867.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15952.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18322.65},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8445.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9036.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4750.54,"10th_percentile":4750.54,"90th_percentile":4750.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6180.29,"maximum":20514.06,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":15633.09},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10784.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17823.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6612.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":10694.48},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10056.0},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":13671.66},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11701.47},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12310.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6365.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6365.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10617.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16984.5},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19106.46},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13535.94},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20514.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6612.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14868.37},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6612.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6489.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10659.46},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6180.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6272.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6489.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12773.63},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6551.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11289.19},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6180.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15547.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6489.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11289.19},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12966.77},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6180.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6612.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52638.31,"maximum":194311.43,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":148078.4},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":102156.4},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":168827.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56322.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":101299.34},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":95251.52},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":129499.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":110837.62},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":116608.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54217.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":54217.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":100566.69},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":160879.06},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":180978.57},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":128213.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194311.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56322.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":140834.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56322.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55270.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100967.57},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52638.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53427.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55270.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":120993.27},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55796.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":106932.46},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52638.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":147269.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55270.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":106932.46},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":122822.69},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52638.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56322.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52321.77,"10th_percentile":52321.77,"90th_percentile":52321.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15294.39,"maximum":54609.5,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":41616.12},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28710.15},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47447.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16365.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28469.28},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26769.59},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36394.68},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31149.93},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32771.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15753.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15753.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28263.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45213.63},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50862.42},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":36033.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54609.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16365.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":39580.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16365.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16059.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28376.04},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15294.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15523.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16059.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34004.08},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16212.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30052.42},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15294.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41388.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16059.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30052.42},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34518.23},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15294.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16365.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":28710.15,"10th_percentile":28710.15,"90th_percentile":28710.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15973.45,"10th_percentile":15958.92,"90th_percentile":15988.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":30749.93,"10th_percentile":25149.93,"90th_percentile":32771.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15675.84,"10th_percentile":15675.84,"90th_percentile":15675.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":54609.5,"10th_percentile":54609.5,"90th_percentile":54609.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16284.61,"10th_percentile":16284.61,"90th_percentile":16284.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"21","median_amount":14724.67,"10th_percentile":6783.71,"90th_percentile":15304.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"1 through 10","median_amount":34004.08,"10th_percentile":34004.08,"90th_percentile":34004.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":5794.91,"10th_percentile":3644.93,"90th_percentile":5794.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"1 through 10","median_amount":30052.42,"10th_percentile":30052.42,"90th_percentile":30052.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":10686.12,"10th_percentile":10686.12,"90th_percentile":10686.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13828.02,"10th_percentile":10056.71,"90th_percentile":15660.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8386.67,"maximum":28768.03,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":21923.18},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15124.37},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24995.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8973.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14997.48},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14102.1},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19172.55},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16409.64},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17264.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8638.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8638.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14889.02},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23818.33},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26794.09},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18982.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28768.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8973.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20850.76},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8973.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8806.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14948.37},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8386.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8512.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8806.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17913.19},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8889.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15831.47},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8386.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21803.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8806.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15831.47},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18184.04},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8386.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8973.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":23805.03,"10th_percentile":23805.03,"90th_percentile":23805.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8764.26,"10th_percentile":8764.26,"90th_percentile":8764.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":23818.33,"10th_percentile":23818.33,"90th_percentile":23818.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3575.5,"10th_percentile":3575.5,"90th_percentile":3575.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8387.58,"10th_percentile":7489.11,"90th_percentile":8395.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3644.93,"10th_percentile":3644.93,"90th_percentile":3644.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":5794.91,"10th_percentile":5794.91,"90th_percentile":5794.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8764.44,"10th_percentile":8764.44,"90th_percentile":8764.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29741.08,"maximum":108653.93,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":82801.62},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":57123.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":94404.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31822.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":56643.97},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":53262.19},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":72412.77},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":61977.54},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":65204.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31822.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31228.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56458.46},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29741.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30187.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31228.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":67656.31},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31525.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":59793.87},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29741.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82349.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31228.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":59793.87},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":68679.27},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29741.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31822.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7912.48,"maximum":26994.1,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":20571.32},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14191.76},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23453.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8466.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14072.69},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13232.52},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17990.31},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15397.77},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16199.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8149.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8149.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13970.91},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22349.62},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25141.88},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17811.71},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26994.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":8308.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16808.61},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8387.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14855.25},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7912.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20458.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8308.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14855.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17062.75},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7912.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8466.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2771.8,"10th_percentile":2771.8,"90th_percentile":2771.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7767.44,"maximum":26451.52,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":20157.84},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13906.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22982.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8311.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":13789.83},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12966.54},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17628.7},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15088.27},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15873.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8000.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8000.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13690.1},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21900.39},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24636.53},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17453.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26451.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8311.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19171.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8311.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8155.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13744.67},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7767.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7883.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8155.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16470.76},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8233.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14556.66},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7767.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20047.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8155.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14556.66},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16719.79},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7767.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8311.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8766.18,"maximum":30187.74,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":23005.09},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15870.76},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26228.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9379.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15737.61},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14798.04},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20118.72},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17219.46},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18116.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9029.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9029.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15623.79},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24993.77},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28116.38},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19918.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30187.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9379.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21879.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9379.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9204.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15686.07},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8766.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8897.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9204.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18797.21},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9292.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16612.76},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8766.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22879.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9204.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16612.76},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19081.43},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8766.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9379.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15473.25,"maximum":55278.59,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":42126.01},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29061.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48028.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16556.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28818.09},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27097.58},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36840.6},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31531.59},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33173.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15937.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15937.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28609.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45767.6},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51485.6},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":36474.87},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55278.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":16246.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34420.71},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16401.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30420.63},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15473.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41895.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16246.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30420.63},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34941.15},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15473.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16556.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12787.41,"maximum":45231.01,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":34469.07},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23779.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39298.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13682.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23580.04},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22172.25},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30144.35},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25800.32},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27143.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13171.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13171.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23409.5},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37448.76},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42127.44},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29845.1},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45231.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13682.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":32782.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13682.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13426.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23502.81},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12787.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12979.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13426.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28164.31},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13554.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24891.29},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12787.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34280.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13426.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24891.29},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28590.15},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12787.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13682.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":20398.06,"10th_percentile":20398.06,"90th_percentile":20398.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13361.45,"10th_percentile":13361.45,"90th_percentile":13361.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11193.5,"maximum":39268.24,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":29925.04},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20644.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34118.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11977.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20471.5},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19249.3},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26170.44},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22399.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23565.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11529.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11529.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20323.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32511.92},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36573.81},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25910.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39268.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11977.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28461.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11977.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11753.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20404.45},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11193.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11361.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11753.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24451.43},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11865.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21609.89},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11193.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29761.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11753.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21609.89},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24821.14},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11193.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11977.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11680.85,"10th_percentile":11680.85,"90th_percentile":11680.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":870.37,"10th_percentile":870.37,"90th_percentile":870.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11203.49,"10th_percentile":11203.49,"90th_percentile":11203.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4892.73,"10th_percentile":4892.73,"90th_percentile":4892.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":291.84,"10th_percentile":291.84,"90th_percentile":11696.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16292.37,"maximum":58342.91,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":44461.23},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30672.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50691.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17432.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30415.6},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28599.71},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38882.82},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33279.51},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35012.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16781.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16781.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30195.62},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48304.68},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54339.66},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38496.82},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58342.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17432.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":42286.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17432.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17106.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30315.98},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16292.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16536.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17106.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36328.79},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17269.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32106.97},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16292.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44218.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17106.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32106.97},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":36878.08},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16292.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17432.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8744.38,"maximum":30106.21,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":22942.96},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15827.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26157.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9356.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15695.11},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14758.07},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20064.38},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17172.95},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18067.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9006.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9006.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15581.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24926.27},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28040.45},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19865.2},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30106.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9356.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21820.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9356.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9181.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15643.71},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8744.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8875.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9181.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18746.45},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9269.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16567.89},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8744.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22817.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9181.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16567.89},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19029.89},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8744.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9356.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5332.61,"maximum":17342.91,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":13216.47},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9117.78},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15068.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5705.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":9041.29},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":8501.5},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":11558.24},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":9892.61},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":10407.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5492.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5492.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":8975.9},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":14358.96},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16152.91},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11443.5},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17342.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5705.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12569.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5705.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5599.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9011.68},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5332.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5412.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5599.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10799.03},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5652.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":9544.06},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5332.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13144.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5599.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":9544.06},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":10962.31},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5332.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5705.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":9892.61,"10th_percentile":9892.61,"90th_percentile":9892.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3889.19,"10th_percentile":3889.19,"90th_percentile":3889.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11334.78,"maximum":39796.76,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":30327.81},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20922.57},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34577.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12128.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20747.03},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19508.38},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26522.68},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22700.56},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23882.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11674.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11674.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20596.98},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32949.51},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37066.07},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26259.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39796.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12128.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28844.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12128.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11901.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20679.08},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11334.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11504.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11901.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24780.53},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12014.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21900.75},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11334.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30162.19},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11901.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21900.75},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25155.21},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11334.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12128.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13810.95,"maximum":49060.0,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":37387.02},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25792.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42625.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14777.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25576.19},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24049.22},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32696.19},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27984.42},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29441.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14225.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14225.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25391.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40618.95},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45693.7},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32371.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49060.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14777.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35558.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14777.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14501.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25492.42},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13810.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14018.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14501.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30548.53},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14639.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26998.44},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13810.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37182.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14501.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26998.44},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31010.43},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13810.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14777.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":28899.79,"10th_percentile":28899.79,"90th_percentile":28899.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13095.36,"10th_percentile":13095.36,"90th_percentile":13411.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":7326.51,"10th_percentile":7326.51,"90th_percentile":7326.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12560.63,"10th_percentile":12560.63,"90th_percentile":12560.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7330.83,"maximum":24818.16,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":18913.11},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13047.78},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21563.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7843.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12938.32},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12165.87},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16540.14},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14156.58},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14893.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7550.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7550.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12844.74},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20548.05},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23115.24},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16375.94},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24818.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7843.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17987.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7843.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7697.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12895.94},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7330.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7440.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7697.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15453.7},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7770.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13657.8},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7330.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18809.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7697.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13657.8},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15687.36},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7330.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7843.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"1 through 10","median_amount":13799.4,"10th_percentile":13799.4,"90th_percentile":13799.4},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":14146.96,"10th_percentile":13556.58,"90th_percentile":16290.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2382.18,"10th_percentile":2382.18,"90th_percentile":2382.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4446.04,"10th_percentile":4446.04,"90th_percentile":4446.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1188.38,"10th_percentile":1188.38,"90th_percentile":1188.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32233.79,"maximum":117979.02,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":89907.96},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":62025.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102506.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34490.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":61505.37},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":57833.34},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":78627.5},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":67296.68},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":70800.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33200.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33200.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":61060.53},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":97680.06},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":109883.77},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":77846.93},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":117979.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34490.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":85509.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34490.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33845.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61303.93},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32233.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32717.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33845.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":73462.83},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34167.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":64925.6},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32233.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89416.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33845.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":64925.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":74573.58},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32233.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34490.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15083.97,"maximum":53822.34,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":41016.25},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28296.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46763.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":15838.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33513.94},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15989.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29619.23},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15083.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40792.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15838.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29619.23},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34020.67},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15083.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16139.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9486.11,"maximum":32880.96,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":25057.51},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17286.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28568.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10150.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17141.66},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16118.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21913.63},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18755.71},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19732.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9770.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9770.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17017.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27223.61},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30624.81},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21696.08},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32880.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10150.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23831.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10150.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9960.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17085.52},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9486.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9628.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9960.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20474.22},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10055.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18094.88},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9486.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24920.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9960.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18094.88},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20783.79},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9486.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10150.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28299.72,"maximum":103261.86,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":78692.49},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":54288.42},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89719.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30280.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":53832.95},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":50618.99},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":68819.2},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":58901.83},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":61968.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29148.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29148.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":53443.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":85495.08},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":96176.45},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":68136.01},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103261.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30280.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":74843.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30280.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29714.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53656.64},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28299.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28724.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29714.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":64298.79},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29997.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":56826.53},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28299.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78262.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29714.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":56826.53},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":65270.99},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28299.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30280.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11844.29,"maximum":41702.82,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":31780.36},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21924.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36233.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":12436.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25967.39},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12554.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22949.68},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11844.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31606.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12436.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22949.68},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26360.02},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11844.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12673.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15458.22,"maximum":55222.37,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":42083.16},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29032.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47979.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16540.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28788.78},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27070.02},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36803.12},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31499.51},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33139.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15921.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15921.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28580.57},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45721.05},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51433.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":36437.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55222.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":16231.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34385.7},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16385.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30389.69},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15458.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41853.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16231.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30389.69},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34905.61},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15458.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16540.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31617.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15690.43,"maximum":56091.06,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":42745.16},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29489.06},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48734.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16788.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":29241.65},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27495.85},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37382.07},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31995.03},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33661.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10561.49,"maximum":36903.94,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":28123.28},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19401.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32064.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11300.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19238.93},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18090.32},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24594.75},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21050.46},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22146.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10878.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10878.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19099.79},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30554.41},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34371.74},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24350.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36903.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11300.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26747.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11300.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11089.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19175.92},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10561.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10719.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11089.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22979.23},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11195.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20308.78},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10561.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27969.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11089.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20308.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23326.68},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10561.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11300.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12980.55,"maximum":45953.51,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":35019.67},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24159.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39926.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13889.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23956.7},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22526.42},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30625.87},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26212.45},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27577.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13369.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13369.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23783.43},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38046.95},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42800.37},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30321.83},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45953.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13889.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33306.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13889.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13629.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23878.24},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12980.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13175.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13629.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28614.2},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13759.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25288.9},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12980.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34828.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13629.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25288.9},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29046.84},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12980.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13889.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":23908.49,"10th_percentile":23908.49,"90th_percentile":23908.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7351.12,"maximum":24894.06,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":18970.95},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13087.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21629.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7865.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12977.89},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12203.08},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16590.73},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14199.88},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14939.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7571.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7571.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12884.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20610.9},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23185.93},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16426.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24894.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7865.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18042.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7865.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7718.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12935.38},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7351.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7461.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7718.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15500.96},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7792.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13699.57},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7351.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18867.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7718.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13699.57},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15735.34},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7351.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7865.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13333.75,"maximum":47274.82,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":36026.6},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24854.05},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41074.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14267.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24645.53},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23174.13},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31506.46},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26966.14},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28370.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13733.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13733.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24467.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39140.92},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44031.01},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31193.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47274.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14267.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":34264.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14267.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14000.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24564.81},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13333.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13533.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14000.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29436.95},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14133.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26016.03},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13333.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35829.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14000.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26016.03},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29882.03},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13333.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14267.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5703.84,"maximum":18731.69,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":14274.81},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9847.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16275.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6103.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":9765.29},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9182.28},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":12483.8},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10684.79},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11241.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5874.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5874.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9694.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":15508.8},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17446.4},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12359.87},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18731.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6103.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13576.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6103.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5989.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9733.31},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5703.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5789.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5989.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11663.79},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6046.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10308.33},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5703.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14196.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5989.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10308.33},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":11840.15},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5703.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6103.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12483.06,"maximum":44092.43,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":33601.4},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23180.95},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38309.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13356.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22986.47},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21614.12},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29385.54},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25150.86},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26460.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12857.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12857.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22820.22},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36506.08},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41066.99},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29093.82},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44092.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13356.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31957.72},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13356.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13107.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22911.19},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12483.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12670.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13107.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27455.34},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13232.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24264.72},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12483.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33417.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13107.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24264.72},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27870.47},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12483.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13356.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":22800.86,"10th_percentile":22800.86,"90th_percentile":22800.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12485.65,"10th_percentile":12485.65,"90th_percentile":12485.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2456.74,"10th_percentile":2456.74,"90th_percentile":2456.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7137.69,"maximum":24095.65,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":18362.51},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12667.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20935.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7637.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12561.66},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11811.7},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16058.63},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13744.46},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14460.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7351.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7351.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12470.81},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19949.86},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22442.31},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15899.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24095.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7637.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17464.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7637.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7494.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12520.52},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7137.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7244.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7494.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15003.81},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7565.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13260.19},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7137.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18262.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7494.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13260.19},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15230.67},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7137.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7637.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":12686.01,"10th_percentile":12686.01,"90th_percentile":12686.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6438.0,"10th_percentile":6438.0,"90th_percentile":6438.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2005.34,"10th_percentile":2005.34,"90th_percentile":2005.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14454.98,"maximum":51469.28,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":39223.06},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27059.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44719.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15466.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26832.2},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25230.25},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34301.87},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29358.71},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30887.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14888.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14888.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26638.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42613.7},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47937.67},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33961.34},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51469.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15466.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":37304.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15466.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15177.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26744.33},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14454.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14671.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15177.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32048.74},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15322.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28324.31},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14454.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39008.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15177.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":28324.31},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32533.32},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14454.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15466.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15083.24,"10th_percentile":15083.24,"90th_percentile":15083.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13075.7,"10th_percentile":13075.7,"90th_percentile":13075.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14457.53,"10th_percentile":14457.53,"90th_percentile":14457.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":5928.48,"10th_percentile":5928.48,"90th_percentile":5928.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8228.86,"maximum":28177.66,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":21473.28},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14813.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24482.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8804.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14689.71},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13812.7},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18779.09},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16072.88},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16909.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8475.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8475.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14583.47},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23329.53},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26244.22},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18592.67},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28177.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8804.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20422.86},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8804.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8640.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14641.6},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8228.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8352.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8640.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17545.58},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8722.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15506.58},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8228.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21356.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8640.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15506.58},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17810.87},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8228.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8804.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8435.8,"10th_percentile":8435.8,"90th_percentile":8435.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5869.92,"maximum":19352.99,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":14748.28},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10174.55},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16814.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6280.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":10089.19},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9486.84},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":12897.86},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11039.18},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11614.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6046.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6046.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10016.22},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16023.2},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18025.07},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12769.82},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19352.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6280.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14026.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6280.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6163.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10056.15},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5869.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5957.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6163.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12050.66},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6222.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10650.24},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5869.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14667.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6163.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10650.24},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12232.87},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5869.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6280.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5438.6,"10th_percentile":5438.6,"90th_percentile":5438.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13843.26,"maximum":49180.88,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":37479.15},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25856.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42730.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14812.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25639.21},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24108.48},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32776.76},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28053.38},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29514.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14258.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14258.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25453.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40719.03},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45806.29},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32451.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49180.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14812.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35645.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14812.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14535.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25555.24},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13843.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14050.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14535.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30623.81},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14673.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27064.97},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13843.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37274.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14535.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27064.97},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31086.84},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13843.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14812.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8344.59,"maximum":28610.6,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":21803.2},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15041.61},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24858.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8928.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14915.41},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14024.92},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19067.63},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16319.84},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17169.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8594.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8594.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14807.54},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23687.99},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26647.46},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18878.34},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28610.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8928.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20736.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8928.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8761.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14866.56},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8344.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8469.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8761.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17815.16},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8845.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15744.84},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8344.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21684.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8761.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15744.84},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18084.53},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8344.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8928.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":161144.06,"maximum":600226.61,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":457413.11},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":315560.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":521507.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":172424.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":312912.93},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":294231.24},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":400022.97},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":342376.62},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":360204.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":165978.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":165978.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":310649.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":496954.24},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":559041.49},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":396051.78},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":600226.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":172424.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":435037.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":172424.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169201.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":311888.1},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":161144.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":163561.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169201.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":373747.33},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":170812.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":330313.59},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161144.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454915.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169201.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":330313.59},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":379398.39},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161144.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":172424.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54598.95,"maximum":201646.12,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":153667.92},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":106012.51},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":175200.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58420.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":105123.09},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":98846.98},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":134387.71},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":115021.42},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":121010.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56236.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":56236.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":104362.79},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":166951.77},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":187809.98},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":133053.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":201646.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58420.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":146150.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58420.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57328.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":104778.8},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54598.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55417.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57328.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":125560.41},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57874.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":110968.84},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54598.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":152828.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57328.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":110968.84},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":127458.88},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54598.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58420.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24900.72,"maximum":90546.35,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":69002.42},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47603.42},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78671.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26643.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":47204.04},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":44385.84},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":60344.91},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":51648.75},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":54338.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25647.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25647.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":46862.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":74967.34},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":84333.43},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":59745.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90546.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26643.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":65627.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26643.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26145.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47049.45},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24900.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25274.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26145.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":56381.13},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26394.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":49829.0},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24900.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68625.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26145.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":49829.0},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":57233.62},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24900.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26643.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29961.27,"maximum":109477.64,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":83429.34},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":57556.28},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95119.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32058.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":57073.4},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":53665.97},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":72961.73},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":62447.39},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":65699.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30860.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":30860.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":56660.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":90641.4},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":101965.73},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":72237.41},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":109477.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32058.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":79348.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32058.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31459.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56886.47},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29961.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30410.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31459.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":68169.22},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31758.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":60247.17},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29961.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82973.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31459.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":60247.17},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":69199.93},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29961.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32058.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17309.14,"maximum":62146.6,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":47359.89},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32672.67},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53996.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":18174.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38697.26},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18347.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34200.19},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17309.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47101.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18174.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":34200.19},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":39282.36},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17309.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18520.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16177.4,"maximum":57912.78,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":44133.44},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30446.8},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50317.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":16986.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36060.96},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17148.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31870.26},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16177.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43892.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16986.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31870.26},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":36606.2},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16177.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17309.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19536.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15934.66,"maximum":57004.73,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":43441.44},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29969.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49528.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17050.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":29717.97},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27943.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37990.99},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":32516.2},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":34209.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17050.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12334.26,"maximum":43535.79,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":33177.21},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22888.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37826.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":12950.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27108.74},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13074.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23958.39},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12334.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32996.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12950.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23958.39},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27518.62},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12334.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13197.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9314.77,"maximum":32239.99,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":24569.04},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16949.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28011.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":9780.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20075.1},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9873.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17742.14},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9314.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24434.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9780.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17742.14},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20378.64},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9314.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9966.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10236.1,"maximum":35686.64,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":27195.63},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18761.73},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31006.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":10747.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22221.25},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10850.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19638.89},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10236.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27047.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10747.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19638.89},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22557.24},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10236.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10952.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6712.35,"maximum":22504.46,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":17149.91},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11831.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19553.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7182.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11732.13},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11031.69},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14998.17},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12836.82},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13505.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6913.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6913.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11647.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18632.44},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20960.29},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14849.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22504.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7182.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16310.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7182.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7047.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11693.7},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6712.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7047.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14013.01},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7115.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12384.54},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6712.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17056.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7047.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12384.54},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14224.89},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6712.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7182.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6431.83,"10th_percentile":6431.83,"90th_percentile":6881.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6723.79,"10th_percentile":6723.79,"90th_percentile":6723.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9637.16,"maximum":33446.04,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":25488.13},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17583.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29059.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10311.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17436.24},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16395.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22290.22},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19078.03},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20071.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9926.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9926.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17310.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27691.46},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31151.1},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":22068.94},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33446.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10311.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":24241.33},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10311.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10119.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17379.14},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9637.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9781.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10119.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20826.08},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10215.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18405.85},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9637.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25348.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10119.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18405.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21140.97},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9637.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10311.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18637.28,"10th_percentile":18637.28,"90th_percentile":18637.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4251.88,"10th_percentile":4251.88,"90th_percentile":4251.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42023.41,"10th_percentile":42023.41,"90th_percentile":42023.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5413.77,"maximum":17646.53,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":13447.84},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9277.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15332.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5792.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":9199.57},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":8650.33},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":11760.59},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10065.8},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":10589.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5576.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5576.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9133.04},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":14610.35},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16435.7},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11643.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17646.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5792.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12790.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5792.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5684.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9169.44},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5413.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5494.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5684.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10988.09},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5738.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":9711.15},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5413.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13374.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5684.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":9711.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":11154.23},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5413.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5792.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4874.95,"maximum":15630.83,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":11911.74},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":8217.68},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13580.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5216.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":8148.74},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":7662.24},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":10417.22},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":8916.02},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":9380.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5021.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5021.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":8089.8},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":12941.46},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14558.3},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":10313.8},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15630.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5216.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":11329.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5216.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5118.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8122.05},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4874.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4948.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5118.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9732.96},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5167.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":8601.88},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4874.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11846.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5118.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":8601.88},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":9880.12},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4874.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5216.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5096.11,"10th_percentile":5096.11,"90th_percentile":5096.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51280.36,"maximum":189231.41,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":144207.09},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":99485.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164413.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54869.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":98651.0},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":92761.29},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":126113.89},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":107939.92},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":113560.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":54357.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":104136.85},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51280.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143419.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53844.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":104136.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":119611.65},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51280.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54869.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28975.31,"maximum":105789.22,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":80618.51},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":55617.14},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91915.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31003.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":55150.53},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":51857.9},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":70503.57},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":60343.47},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":63485.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29844.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29844.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":54751.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":87587.59},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":98530.39},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":69803.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105789.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31003.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":76674.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31003.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30424.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54969.9},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28975.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29409.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30424.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":65872.52},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30713.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":58217.37},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28975.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80178.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30424.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":58217.37},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":66868.51},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28975.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31003.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":57959.63,"maximum":214218.25,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":163248.74},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":112622.12},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186123.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62016.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":111677.25},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":105009.84},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":142766.45},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":122192.72},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":128555.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59698.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":59698.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":110869.55},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":177360.79},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":199519.46},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":141349.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":214218.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62016.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":155263.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62016.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60857.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111311.5},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57959.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58829.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60857.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":133388.79},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61437.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":117887.47},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57959.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":162357.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60857.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":117887.47},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":135405.62},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57959.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62016.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34629.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22821.34,"maximum":82767.48,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":63074.4},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":43513.8},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71912.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24418.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":43148.73},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":40572.64},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":55160.66},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":47211.59},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":49669.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21240.95,"maximum":76855.32,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":58568.93},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":40405.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66775.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22727.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":40066.57},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":37674.5},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51220.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":43839.22},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":46121.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21878.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21878.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":39776.79},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":63631.93},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":71581.82},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":50711.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76855.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22727.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":55703.91},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22727.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22303.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39935.35},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21240.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21559.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22303.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":47856.04},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22515.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":42294.62},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21240.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58249.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22303.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":42294.62},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":48579.63},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21240.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22727.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12214.02,"maximum":43085.98,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":32834.42},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22651.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37435.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13069.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22461.79},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21120.76},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28714.79},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24576.77},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25856.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12580.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12580.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22299.33},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35672.8},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40129.6},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28429.73},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43085.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13069.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31228.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13069.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12824.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22388.22},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12214.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12397.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12824.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26828.65},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12946.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23710.85},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12214.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32655.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12824.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23710.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27234.3},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12214.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13069.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7764.44,"maximum":26440.28,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":20149.27},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13900.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22972.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":8152.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16463.75},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8230.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14550.48},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7764.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20039.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8152.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14550.48},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16712.69},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7764.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8307.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46697.76,"maximum":172088.11,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":131142.73},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":90472.81},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":149518.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49966.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":89713.77},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":84357.64},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":114688.68},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":98161.17},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":103272.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":49499.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":94702.63},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46697.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130426.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49032.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":94702.63},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":108775.5},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46697.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49966.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20516.51,"maximum":74145.23,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":56503.66},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":38980.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64421.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21952.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":38653.73},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":36346.01},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":49414.33},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":42293.35},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":44495.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21132.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21132.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":38374.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":61388.12},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":69057.68},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":48923.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74145.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21952.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":53739.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21952.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21542.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38527.14},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20516.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20824.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21542.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":46168.53},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21747.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":40803.22},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20516.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56195.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21542.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40803.22},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":46866.6},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20516.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21952.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22384.72,"maximum":81134.12,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":61829.66},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":42655.08},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70493.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23951.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":42297.22},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":39771.97},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":54072.1},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":46279.9},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":48689.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23056.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23056.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":41991.3},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":67174.54},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":75567.02},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":53535.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81134.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23951.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":58805.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23951.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23503.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42158.69},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22384.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22720.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23503.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50520.35},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23727.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":44649.31},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22384.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61492.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23503.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":44649.31},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":51284.22},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22384.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23951.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10428.48,"maximum":36406.34,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":27744.08},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19140.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31631.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11158.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18979.52},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17846.4},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24263.12},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20766.62},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21847.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10741.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10741.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18842.25},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30142.42},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33908.28},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24022.25},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36406.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11158.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26386.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11158.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10949.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18917.36},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10428.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10584.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10949.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22669.39},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11054.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20034.95},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10428.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27592.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10949.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20034.95},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23012.15},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10428.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11158.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7480.37,"maximum":25377.61,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":19339.44},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13341.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22049.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8004.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":13229.97},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12440.11},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16912.99},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14475.7},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15229.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7704.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7704.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13134.29},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21011.25},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23636.3},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16745.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25377.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8004.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18393.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8004.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7854.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13186.64},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7480.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7592.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7854.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15802.05},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7929.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13965.67},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7480.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19233.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7854.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13965.67},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16040.98},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7480.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8004.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Hmo","methodology":"fee schedule","standard_charge_dollar":10971.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22716.65},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11075.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20076.72},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10448.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27650.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10971.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20076.72},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23060.13},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10448.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11180.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35955.18,"maximum":131900.57,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":100517.12},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":69344.8},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114601.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38472.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":68763.02},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":64657.7},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":87905.56},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":75237.7},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":79155.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":38112.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":72586.84},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35955.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99968.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37752.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":72586.84},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":83373.29},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35955.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38472.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10118.17,"10th_percentile":10118.17,"90th_percentile":10118.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19172.09,"maximum":69115.81,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":52670.9},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":36336.63},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60051.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20514.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":36031.78},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":33880.59},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46062.46},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":39424.51},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":41477.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19747.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19747.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":35771.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":57224.05},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64373.36},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":45605.18},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69115.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20514.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":50094.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20514.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20130.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35913.77},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19172.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19459.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20130.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":43036.83},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20322.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38035.45},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19172.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52383.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20130.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":38035.45},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":43687.55},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19172.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20514.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":37079.51,"10th_percentile":37079.51,"90th_percentile":37079.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19183.55,"10th_percentile":19183.55,"90th_percentile":19183.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"1 through 10","median_amount":80898.38,"10th_percentile":80898.38,"90th_percentile":80898.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13577.23,"maximum":48185.68,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":36720.74},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25332.92},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41866.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14527.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25120.38},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23620.63},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32113.5},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27485.7},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28916.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13984.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13984.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24938.7},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39895.06},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44879.38},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31794.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48185.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14527.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":34924.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14527.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14256.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25038.11},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13577.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13780.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14256.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30004.12},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14391.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26517.29},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13577.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36520.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14256.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26517.29},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30457.78},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13577.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14527.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26460.82,"maximum":96382.61,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":73450.04},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":50671.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83742.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28313.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":50246.63},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":47246.78},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":64234.5},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":54977.82},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":57840.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27254.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":27254.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":49883.22},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":79799.44},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":89769.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":63596.82},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96382.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28313.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":69857.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28313.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27783.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50082.07},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26460.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26857.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27783.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":60015.24},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28048.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":53040.78},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26460.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73048.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27783.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":53040.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":60922.67},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26460.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28313.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27118.08,"10th_percentile":27118.08,"90th_percentile":27118.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21433.08,"10th_percentile":21433.08,"90th_percentile":21433.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13048.18,"maximum":46206.53,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":35212.49},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24292.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40146.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13961.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24088.6},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22650.45},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30794.49},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26356.77},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27729.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13439.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13439.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23914.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38256.43},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43036.02},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30488.78},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46206.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13961.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33489.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13961.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13700.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24009.71},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13048.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13243.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13700.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28771.74},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13831.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25428.14},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13048.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35020.19},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13700.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25428.14},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29206.77},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13048.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13961.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13893.53,"10th_percentile":13893.53,"90th_percentile":13893.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9708.55,"maximum":33713.11,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":25691.66},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17724.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29291.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10388.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17575.48},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16526.18},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22468.21},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19230.37},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20231.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9999.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9999.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17448.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27912.58},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31399.85},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":22245.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33713.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10388.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":24434.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10388.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10193.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17517.91},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9708.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9854.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10193.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20992.38},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10291.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18552.82},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9708.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25551.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10193.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18552.82},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21309.78},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9708.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10388.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","code_information":[{"code":"222","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":111403.53,"maximum":215250.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":113164.55},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187020.11},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":112215.13},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":143454.06},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":122781.24},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":129174.5},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":111403.53},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":178215.02},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":200480.41},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":142029.93},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":215250.0},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111847.61},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":134031.23},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":118455.26},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":163139.18},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":118455.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","code_information":[{"code":"223","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":75932.09,"maximum":146713.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":77132.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":127471.97},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":76485.27},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":97777.56},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":83687.07},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":88044.69},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":75932.09},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":121470.46},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":136646.44},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":96806.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146713.31},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76234.77},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":91355.01},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":80738.51},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111194.84},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":80738.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","code_information":[{"code":"224","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":103147.86,"maximum":199298.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":104778.38},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173160.8},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":103899.32},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":132823.25},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":113682.41},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":119601.89},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":103147.86},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":165008.22},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":185623.61},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":131504.66},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":199298.68},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103559.03},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":124098.71},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":109677.01},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":151049.58},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":109677.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","code_information":[{"code":"225","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":73589.54,"maximum":142187.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":74752.81},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":123539.38},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":74125.65},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":94761.07},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":81105.28},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":85328.46},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":73589.54},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":117723.03},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":132430.82},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":93820.34},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":142187.12},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73882.88},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":88536.66},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":78247.68},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":107764.41},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":78247.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","code_information":[{"code":"226","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":93133.1,"maximum":179948.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":94605.3},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":156348.38},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":93811.59},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":119927.26},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":102644.83},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":107989.58},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":93133.1},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":148987.35},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":167601.17},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":118736.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":179948.5},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93504.35},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":112049.8},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":99028.32},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":136383.98},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":99028.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","code_information":[{"code":"227","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":73051.19,"maximum":141146.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":74205.95},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":122635.62},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":73583.38},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":94067.84},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":80511.95},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":84704.23},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":73051.19},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":116861.81},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":131462.01},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":93133.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141146.94},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73342.39},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":87888.96},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":77675.25},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":106976.05},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":77675.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43583.07,"maximum":84209.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":44272.01},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73165.64},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":43900.58},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":56121.81},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":48034.23},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":50535.39},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":43583.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":69720.93},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":78431.55},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":55564.67},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84209.68},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43756.8},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":52435.44},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":46341.83},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63822.99},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":46341.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27783.23,"maximum":53681.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28222.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46641.45},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":27985.63},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35776.39},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30620.74},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32215.17},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27783.23},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44445.52},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49998.35},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":35421.23},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53681.77},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27893.98},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33426.41},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29541.87},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40685.72},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29541.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"248","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43792.59,"maximum":84614.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":44484.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73517.37},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":44111.63},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":56391.61},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":48265.15},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":50778.34},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":43792.59},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":70056.1},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":78808.6},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":55831.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84614.51},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43967.16},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":52687.51},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":46564.62},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64129.81},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":46564.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26432.99,"maximum":51072.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26850.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44374.71},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26625.56},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34037.69},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29132.6},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30649.55},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26432.99},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42285.51},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47568.47},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33699.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51072.89},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26538.35},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31801.91},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28106.17},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38708.43},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":28106.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Mcc","code_information":[{"code":"338","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38652.08,"maximum":74682.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":39263.07},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64887.67},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":38933.66},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":49772.18},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":42599.63},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":44817.81},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":38652.08},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":61832.69},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":69557.8},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":49278.08},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74682.18},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38806.15},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":46502.88},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41098.71},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56602.05},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":41098.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Cc","code_information":[{"code":"339","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23693.22,"maximum":45779.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24067.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39775.3},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23865.83},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30509.7},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26113.02},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27472.74},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23693.22},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37902.64},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42638.03},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30206.82},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45779.21},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23787.67},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28505.66},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25192.98},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34696.32},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25192.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16768.82,"maximum":60125.27,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":45819.51},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31609.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52239.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17942.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":31344.79},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":29473.42},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40070.68},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":34296.19},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":36082.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17271.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17271.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":31118.09},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49780.38},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55999.72},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":39672.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60125.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17942.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":43578.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17942.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17607.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31242.13},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16768.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17020.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17607.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37438.63},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17774.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33087.83},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16768.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45569.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17607.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33087.83},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":38004.7},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16768.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17942.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16057.9,"10th_percentile":16057.9,"90th_percentile":16057.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9786.7,"maximum":34005.48,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":25914.47},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17877.89},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29545.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10471.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17727.9},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16669.5},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22663.07},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19397.15},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20407.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10080.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10080.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17599.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28154.65},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31672.17},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":22438.08},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34005.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10471.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":24646.81},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10471.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10276.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17669.84},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9786.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9933.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10276.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21174.44},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10373.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18713.72},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25772.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10276.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18713.72},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21494.59},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10471.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10226.92,"10th_percentile":10226.92,"90th_percentile":10226.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7642.7,"maximum":25984.85,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":19802.2},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13661.15},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22576.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8177.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":13546.54},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12737.78},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17317.68},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14822.07},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15593.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7871.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7871.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13448.57},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21514.01},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24201.87},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17145.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25984.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8177.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18833.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8177.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8024.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13502.17},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7642.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7757.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8024.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16180.17},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8101.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14299.85},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7642.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19694.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8024.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14299.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16424.81},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7642.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8177.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14433.93,"maximum":51390.56,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":39163.07},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27017.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44650.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15444.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26791.17},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25191.67},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34249.41},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29313.81},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30840.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14866.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14866.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26597.4},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42548.53},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47864.35},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33909.4},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51390.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15444.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":37247.33},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15444.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15155.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26703.42},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14433.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14650.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15155.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31999.72},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15299.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28280.99},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14433.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38949.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15155.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":28280.99},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32483.56},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14433.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15444.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":31476.35,"10th_percentile":31476.35,"90th_percentile":31476.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14432.88,"10th_percentile":14432.88,"90th_percentile":14432.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15081.38,"10th_percentile":15081.38,"90th_percentile":15081.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8066.54,"maximum":27570.42,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":21010.52},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14494.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23954.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8631.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14373.14},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13515.03},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18374.4},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15726.51},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16545.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8308.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8308.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14269.19},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22826.77},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25678.65},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18191.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27570.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8631.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19982.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8631.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8469.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14326.07},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8066.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8187.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8469.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17167.47},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8550.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15172.41},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8066.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20895.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8469.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15172.41},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17427.04},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8066.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8631.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8433.79,"10th_percentile":8433.79,"90th_percentile":8433.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8069.94,"10th_percentile":8067.54,"90th_percentile":8149.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6610.13,"10th_percentile":6428.83,"90th_percentile":8430.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5434.06,"maximum":17722.44,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":13505.69},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9317.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15398.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5814.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":9239.14},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":8687.54},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":11811.17},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10109.09},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":10635.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5597.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5597.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9172.32},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":14673.19},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16506.39},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11693.92},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17722.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5814.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12845.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5814.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5705.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9208.88},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5434.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5515.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5705.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11035.35},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5760.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":9752.92},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5434.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13431.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5705.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":9752.92},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":11202.21},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5434.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5814.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2427.31,"10th_percentile":2427.31,"90th_percentile":2427.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15442.44,"maximum":55163.33,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":42038.17},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29001.32},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47928.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16523.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28758.0},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27041.08},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36763.78},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31465.84},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33104.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15905.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15905.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28550.01},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45672.17},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51378.24},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":36398.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55163.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16523.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":39981.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16523.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16214.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28663.82},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15442.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15674.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16214.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34348.94},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16368.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30357.2},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15442.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41808.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16214.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30357.2},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34868.29},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15442.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16523.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15827.55,"10th_percentile":15827.55,"90th_percentile":15827.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8839.07,"maximum":30460.44,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":23212.9},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16014.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26465.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9457.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15879.78},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14931.71},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20300.46},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17375.01},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18279.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9104.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9104.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15764.93},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25219.55},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28370.36},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20098.93},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30460.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9457.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22077.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9457.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9281.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15827.77},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8839.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8971.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9281.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18967.01},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9369.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16762.83},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8839.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23086.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9281.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16762.83},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19253.8},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8839.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9457.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9412.97,"10th_percentile":9412.97,"90th_percentile":9412.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8847.34,"10th_percentile":8847.34,"90th_percentile":8847.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6713.1,"maximum":22507.27,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":17152.05},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11832.87},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19555.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7183.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11733.59},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11033.07},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15000.04},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12838.42},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13506.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6914.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6914.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11648.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18634.77},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20962.91},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14851.13},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22507.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7183.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16313.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7183.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7048.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11695.16},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6713.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7048.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14014.76},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7115.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12386.08},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6713.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17058.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7048.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12386.08},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14226.66},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6713.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7183.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11072.51,"maximum":38815.62,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":29580.12},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20406.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33724.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11847.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20235.54},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19027.43},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25868.8},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22140.91},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23293.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11404.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11404.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20089.19},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32137.17},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36152.25},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25611.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38815.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11847.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28133.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11847.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11626.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20169.27},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11072.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11238.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11626.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24169.6},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11736.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21360.81},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11072.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29418.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11626.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21360.81},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24535.04},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11072.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11847.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7120.41,"maximum":24030.99,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":18313.24},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12633.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20879.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7618.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12527.95},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11780.0},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16015.53},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13707.57},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14421.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7334.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7334.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12437.34},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19896.32},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22382.08},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15856.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24030.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":7476.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14963.55},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7547.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13224.61},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7120.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18213.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7476.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13224.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15189.8},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7120.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7618.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7124.73,"10th_percentile":7124.73,"90th_percentile":7124.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12587.52,"maximum":44483.2,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":33899.2},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23386.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38649.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13468.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23190.19},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21805.68},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29645.97},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25373.76},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26694.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12965.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12965.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23022.47},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36829.61},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41430.94},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29351.67},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44483.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13468.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":32240.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13468.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13216.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23114.24},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12587.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12776.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13216.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27698.67},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13342.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24479.76},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12587.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33714.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13216.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24479.76},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28117.47},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12587.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13468.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":22678.96,"10th_percentile":22678.96,"90th_percentile":22678.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8033.47,"maximum":27446.72,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":20916.25},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14429.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23847.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8595.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14308.65},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13454.39},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18291.96},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15655.95},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16471.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8274.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8274.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14205.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22724.36},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25563.44},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18110.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27446.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8595.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19893.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8595.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8435.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14261.79},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8033.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8153.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8435.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17090.44},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8515.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15104.34},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8033.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20802.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8435.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15104.34},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17348.85},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8033.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8595.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":13853.32,"10th_percentile":13853.32,"90th_percentile":13853.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5816.57,"maximum":19153.39,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":14596.17},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10069.61},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16641.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6223.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":9985.13},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9389.0},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":12764.84},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10925.33},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11494.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5991.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5991.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9912.92},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":15857.94},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17839.16},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12638.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19153.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6223.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13882.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6223.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6107.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9952.43},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5816.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5903.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6107.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11926.37},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6165.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10540.39},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5816.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14516.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6107.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10540.39},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12106.7},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5816.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6223.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":19153.39,"10th_percentile":19153.39,"90th_percentile":19153.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11794.69,"maximum":41517.28,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":31638.96},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21827.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36072.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12620.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21643.98},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20351.78},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27669.32},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23681.96},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24915.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12148.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12148.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21487.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34374.0},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38668.53},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27394.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41517.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12620.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30091.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12620.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12384.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21573.09},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11794.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11971.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12384.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25851.86},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12502.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22847.57},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11794.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31466.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12384.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22847.57},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26242.74},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11794.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12620.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":23681.96,"10th_percentile":23681.96,"90th_percentile":23681.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11800.5,"10th_percentile":11800.5,"90th_percentile":11800.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4121.1,"10th_percentile":4121.1,"90th_percentile":4121.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11417.93,"10th_percentile":11417.93,"90th_percentile":11417.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6631.94,"maximum":22203.65,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":16920.68},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11673.24},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19291.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7096.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11575.31},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10884.23},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14797.69},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12665.23},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13324.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7096.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6963.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11537.4},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6631.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6731.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6963.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13825.7},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7029.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12219.0},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6631.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16828.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6963.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12219.0},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14034.75},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6631.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7096.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":14197.69,"10th_percentile":14197.69,"90th_percentile":14197.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7063.51,"10th_percentile":7063.51,"90th_percentile":7063.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5930.3,"10th_percentile":5930.3,"90th_percentile":6635.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2570.32,"10th_percentile":2570.32,"90th_percentile":2570.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4784.77,"maximum":15293.47,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":11654.66},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":8040.32},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13287.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5119.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":7972.86},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":7496.86},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":10192.38},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":8723.58},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":9177.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4928.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":4928.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":7915.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":12662.14},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14244.1},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":10091.2},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15293.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5119.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":11084.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5119.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5024.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7946.75},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4784.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4856.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5024.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9522.89},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5071.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":8416.22},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4784.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11591.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5024.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":8416.22},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":9666.88},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4784.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5119.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4790.35,"10th_percentile":4790.35,"90th_percentile":4790.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10227.83,"maximum":35655.72,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":27172.06},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18745.47},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30979.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10943.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18588.2},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17478.44},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23762.87},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20338.46},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21397.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10534.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10534.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18453.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29520.95},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33209.17},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":23526.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35655.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10943.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25842.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10943.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10739.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18527.33},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10227.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10381.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10739.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22202.0},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10841.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19621.87},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10227.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27023.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10739.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19621.87},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22537.69},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10227.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10943.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10674.48,"10th_percentile":10674.48,"90th_percentile":10674.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":20338.46,"10th_percentile":20338.46,"90th_percentile":20338.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10891.31,"10th_percentile":10891.31,"90th_percentile":10891.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6555.29,"maximum":21916.89,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":16702.15},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11522.49},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19042.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7014.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11425.82},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10743.67},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14606.59},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12501.67},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13152.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6751.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6751.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11343.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18145.97},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20413.05},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14461.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21916.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7014.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15885.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7014.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6883.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11388.4},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6555.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6653.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6883.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13647.15},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12061.19},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6555.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16610.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6883.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12061.19},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13853.49},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6555.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7014.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":11522.49,"10th_percentile":11522.49,"90th_percentile":11522.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6847.65,"10th_percentile":6847.65,"90th_percentile":6847.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":14556.59,"10th_percentile":14556.59,"90th_percentile":14606.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6605.88,"10th_percentile":6605.88,"90th_percentile":6720.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":21916.89,"10th_percentile":21916.89,"90th_percentile":21916.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":6559.18,"10th_percentile":6144.45,"90th_percentile":6564.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3886.81,"10th_percentile":3886.81,"90th_percentile":3886.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3886.81,"10th_percentile":3886.81,"90th_percentile":3886.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12715.27,"maximum":44961.12,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":34263.4},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23637.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39064.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13605.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23439.34},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22039.95},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29964.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25646.37},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26981.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13096.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13096.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23269.82},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37225.31},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41876.07},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29667.02},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44961.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13605.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":32587.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13605.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13351.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23362.57},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12715.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12906.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13351.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27996.26},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13478.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24742.77},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12715.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34076.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13351.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24742.77},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28419.56},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12715.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13605.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":29359.77,"10th_percentile":29359.77,"90th_percentile":29359.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":42150.24,"10th_percentile":42150.24,"90th_percentile":42150.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12719.59,"10th_percentile":12719.59,"90th_percentile":12719.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11251.47,"10th_percentile":11251.47,"90th_percentile":11251.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7728.37,"maximum":26305.33,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":20046.44},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13829.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22855.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8269.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":13713.62},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12894.88},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17531.28},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15004.89},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15786.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7960.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7960.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13614.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21779.35},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24500.37},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17357.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26305.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8269.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19065.82},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8269.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8114.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13668.71},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7728.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7844.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8114.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16379.73},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8192.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14476.21},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7728.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19936.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8114.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14476.21},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16627.39},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7728.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8269.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7729.48,"10th_percentile":7729.48,"90th_percentile":7729.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3131.77,"10th_percentile":3131.77,"90th_percentile":3131.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5573.84,"maximum":18245.34,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":13904.18},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9592.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15852.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5964.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":9511.74},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":8943.87},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":12159.66},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10407.36},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":10949.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5741.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5741.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9442.95},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":15106.12},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16993.42},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12038.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18245.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5964.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13224.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5964.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5852.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9480.59},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5573.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5657.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5852.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11360.95},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5908.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10040.68},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5573.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13828.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5852.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10040.68},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":11532.73},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5573.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5964.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18694.14,"maximum":67327.82,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":51308.34},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":35396.62},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58497.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20002.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35099.65},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":33004.12},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":44870.85},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":38404.62},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":40404.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19254.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19254.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":34845.8},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":55743.69},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62708.06},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":44425.4},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67327.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20002.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":48798.48},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20002.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19628.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34984.7},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18694.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18974.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19628.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":41923.49},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19815.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":37051.5},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18694.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51028.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19628.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":37051.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":42557.37},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18694.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20002.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12071.24,"maximum":42551.84,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":32427.37},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22371.01},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36971.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12916.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22183.32},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20858.92},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28358.81},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24272.09},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25535.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12433.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12433.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22022.88},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35230.55},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39632.1},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28077.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42551.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12916.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30841.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12916.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12674.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22110.67},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12071.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12252.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12674.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26496.05},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12795.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23416.91},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12071.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32250.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12674.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23416.91},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26896.67},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12071.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12916.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":12596.52,"10th_percentile":12596.52,"90th_percentile":12596.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9298.98,"maximum":32180.95,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":24524.05},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16918.67},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27960.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9949.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16776.72},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15775.11},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21447.1},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18356.41},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19312.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9577.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9577.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16655.39},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26644.04},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29972.82},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21234.19},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32180.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9949.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23324.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9949.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9763.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16721.78},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9298.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9438.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9763.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20038.34},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9856.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17709.65},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9298.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24390.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9763.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17709.65},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20341.32},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9298.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9949.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8638.16,"10th_percentile":8638.16,"90th_percentile":8638.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6163.01,"maximum":20449.4,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":15583.82},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10750.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17767.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6594.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":10660.77},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10024.3},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":13628.57},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11664.59},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12271.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6347.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6347.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10583.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16930.96},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19046.24},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13493.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20449.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6594.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14821.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6594.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6471.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10625.86},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6163.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6255.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6471.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12733.37},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6532.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11253.61},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6163.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15498.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6471.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11253.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12925.9},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6163.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6594.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8369.39,"maximum":28703.37,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":21873.9},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15090.38},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24938.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8955.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14963.78},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14070.4},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19129.46},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16372.76},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17225.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8620.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8620.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14855.55},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23764.8},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26733.86},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18939.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28703.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8955.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20803.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8955.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8787.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14914.77},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8369.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8494.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8787.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17872.93},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8871.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15795.89},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8369.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21754.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8787.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15795.89},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18143.17},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8369.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8955.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":19957.77,"10th_percentile":19957.77,"90th_percentile":19957.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2227.71,"10th_percentile":2227.71,"90th_percentile":2227.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6738.87,"10th_percentile":6738.87,"90th_percentile":6738.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14021.36,"maximum":49847.16,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":37986.89},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26206.42},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43309.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15002.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25986.55},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24435.09},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33220.8},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28433.43},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29913.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14442.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14442.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25798.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41270.68},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46426.85},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32891.01},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49847.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15002.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":36128.69},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15002.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14722.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25901.44},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14021.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14231.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14722.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31038.68},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14862.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27431.63},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14021.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37779.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14722.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27431.63},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31507.99},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14021.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15002.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1350.0,"10th_percentile":1350.0,"90th_percentile":1350.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5963.11,"maximum":19701.59,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":15013.94},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10357.82},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17117.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6380.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":10270.92},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9657.72},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":13130.19},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11238.03},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11823.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6142.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6142.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10196.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16311.82},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18349.75},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12999.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19701.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6380.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14279.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6380.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6261.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10237.29},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5963.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6052.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6261.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12267.73},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6320.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10842.08},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5963.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14931.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6261.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10842.08},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12453.22},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5963.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6380.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5978.8,"10th_percentile":5978.8,"90th_percentile":5978.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8213.08,"maximum":28118.62,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":21428.28},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14782.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24430.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8788.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14658.93},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13783.76},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18739.75},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16039.21},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16874.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8459.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8459.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14552.91},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23280.66},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26189.24},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18553.71},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28118.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8788.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20380.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8788.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8623.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14610.92},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8213.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8336.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8623.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17508.82},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8705.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15474.09},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8213.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21311.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8623.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15474.09},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17773.55},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8213.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8788.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12659.66,"maximum":44753.08,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":34104.87},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23528.28},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38883.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13545.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23330.89},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21937.97},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29825.84},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25527.71},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26856.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13039.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13039.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23162.15},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37053.06},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41682.31},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29529.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44753.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13545.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":32436.55},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13545.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13292.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23254.48},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12659.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12849.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13292.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27866.72},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13419.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24628.28},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12659.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33918.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13292.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24628.28},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28288.06},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12659.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13545.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":5188.95,"10th_percentile":5188.95,"90th_percentile":5188.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11395.43,"10th_percentile":11395.43,"90th_percentile":11395.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18839.93,"maximum":67873.22,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":51723.96},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":35683.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58971.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20158.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35383.98},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":33271.47},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":45234.32},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":38715.71},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":40731.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19405.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19405.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":35128.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":56195.25},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":63216.03},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":44785.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67873.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20158.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":49193.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20158.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19781.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35268.09},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18839.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19122.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19781.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":42263.09},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19970.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":37351.64},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18839.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51441.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19781.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":37351.64},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":42902.11},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18839.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20158.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26537.47,"maximum":96669.36,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":73668.57},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":50822.51},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83991.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28395.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":50396.12},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":47387.35},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":64425.61},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":55141.39},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":58012.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27333.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":27333.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":50031.63},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":80036.85},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":90036.3},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":63786.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96669.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28395.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":70064.91},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28395.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27864.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50231.07},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26537.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26935.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27864.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":60193.79},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28129.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":53198.58},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26537.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73266.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27864.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":53198.58},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":61103.92},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26537.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28395.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11201.76,"maximum":39299.16,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":29948.61},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20660.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34145.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11985.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20487.62},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19264.46},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26191.05},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22416.72},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23583.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11537.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11537.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20339.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32537.52},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36602.61},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25931.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39299.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11985.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28483.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11985.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11761.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20420.52},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11201.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11369.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11761.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24470.69},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11873.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21626.91},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11201.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29785.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11761.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21626.91},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24840.68},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11201.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11985.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18172.61,"maximum":65376.78,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":49821.51},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":34370.89},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56802.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19444.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":34082.53},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":32047.72},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43570.57},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":37291.72},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":39233.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18717.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18717.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33836.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54128.34},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60890.89},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":43138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65376.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19444.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":47384.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19444.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19081.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33970.9},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18172.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18445.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19081.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40708.62},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19262.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35977.81},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18172.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49549.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19081.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":35977.81},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":41324.14},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18172.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19444.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18983.49,"10th_percentile":18983.49,"90th_percentile":18983.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33708.21,"maximum":123494.79,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":94111.35},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":64925.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":107298.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36067.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":64380.88},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":60537.18},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":82303.5},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":70442.94},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":74110.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34719.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":34719.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":63915.24},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":102246.81},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":115021.08},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":81486.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":123494.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36067.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":89507.69},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36067.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35393.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64170.02},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33708.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34213.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35393.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":76897.37},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35730.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":67961.01},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33708.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93597.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35393.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":67961.01},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":78060.06},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33708.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36067.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10804.22,"maximum":37811.99,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":28815.28},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19879.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32852.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11560.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19712.32},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18535.45},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25199.92},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21568.42},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22691.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11128.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11128.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19569.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31306.22},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35217.48},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24949.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37811.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11560.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27405.72},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11560.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11344.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19647.76},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10804.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10966.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11344.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23544.66},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20808.5},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10804.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28657.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11344.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20808.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23900.65},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10804.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11560.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":24949.92,"10th_percentile":24949.92,"90th_percentile":24949.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10804.36,"10th_percentile":10804.36,"90th_percentile":10804.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13339.76,"maximum":47297.31,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":36043.74},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24865.87},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41094.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14273.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24657.25},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23185.15},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31521.45},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26978.97},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28383.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13739.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13739.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24478.92},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39159.54},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44051.96},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31208.52},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47297.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14273.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":34280.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14273.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14006.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24576.5},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13339.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13539.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14006.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29450.95},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14140.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26028.41},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13339.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35846.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14006.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26028.41},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29896.25},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13339.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14273.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"1 through 10","median_amount":35846.9,"10th_percentile":35846.9,"90th_percentile":35846.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"340","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17458.55,"maximum":33732.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17734.52},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29308.76},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17585.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22481.33},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19241.6},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20243.51},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17458.55},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27928.87},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31418.18},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":22258.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33732.79},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17528.14},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21004.63},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18563.65},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25566.27},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18563.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Mcc","code_information":[{"code":"341","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32868.45,"maximum":63507.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33388.02},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55178.33},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":33107.9},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42324.62},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":36225.32},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":38111.59},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":32868.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":52580.48},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":59149.66},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":41904.45},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63507.27},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32999.47},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39544.52},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34948.99},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48132.51},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":34948.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Cc","code_information":[{"code":"342","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21144.06,"maximum":40853.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21478.3},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35495.86},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21298.1},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27227.16},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23303.52},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24516.94},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21144.06},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33824.68},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38050.59},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26956.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40853.81},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21228.35},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25438.73},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22482.46},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30963.33},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22482.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"343","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15898.79,"maximum":30719.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16150.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26690.29},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16014.61},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20472.83},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17522.54},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18434.94},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15898.79},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25433.69},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28611.26},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20269.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30719.08},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15962.16},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19128.06},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16905.16},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23282.16},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16905.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":128933.37,"maximum":249120.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":130971.49},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":216448.56},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":129872.68},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":166027.19},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":142101.41},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":149500.68},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":128933.37},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":206257.95},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":232026.9},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":164378.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":249120.54},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129447.33},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":155121.64},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":137094.72},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":188809.85},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":137094.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":88992.17,"maximum":171947.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":90398.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":149396.74},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":89640.49},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":114595.0},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":98080.99},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":103188.1},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":88992.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":142363.0},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":160149.2},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":113457.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171947.54},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89346.91},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":107067.79},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":94625.28},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130320.0},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":94625.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":67011.48,"maximum":129477.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":68070.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":112496.39},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":67499.67},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":86290.52},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":73855.4},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":77701.08},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":67011.48},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":107199.95},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":120593.03},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":85433.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129477.23},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67278.6},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":80622.5},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":71253.24},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98131.52},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":71253.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":96499.97,"maximum":186453.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":98025.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":162000.56},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":97202.99},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":124262.77},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":106355.56},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":111893.53},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":96499.97},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":154373.41},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":173660.14},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":123029.17},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186453.85},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96884.64},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":116100.53},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":102608.31},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141314.42},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":102608.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":53222.45,"maximum":102834.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":54063.76},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89347.87},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":53610.18},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":68534.41},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":58658.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":61712.43},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":53222.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":85141.28},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":95778.45},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":67854.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102834.54},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53434.6},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":64032.71},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":56591.37},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77938.88},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":56591.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33976.67,"10th_percentile":33976.67,"90th_percentile":33976.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":64748.98,"10th_percentile":64748.98,"90th_percentile":64748.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":78759.82,"10th_percentile":78759.82,"90th_percentile":78759.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22497.21,"maximum":43468.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22852.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37767.48},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22661.11},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28969.6},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24794.86},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26085.94},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22497.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35989.35},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40485.7},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28682.01},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43468.32},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22586.89},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27066.73},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23921.26},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32944.88},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23921.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14517.99,"maximum":28051.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14747.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24372.26},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14623.76},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18694.78},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16000.72},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16833.88},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14517.99},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23224.79},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26126.4},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18509.19},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28051.15},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14575.86},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17466.81},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15436.96},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21260.12},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15436.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9700.49,"maximum":18742.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9853.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16284.81},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":9771.16},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":12491.29},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10691.2},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11247.9},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9700.49},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":15518.11},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17456.87},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12367.29},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18742.94},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9739.15},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11670.8},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10314.52},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14205.38},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10314.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5319.08,"10th_percentile":5319.08,"90th_percentile":5319.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17865.95,"maximum":34519.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18148.36},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29992.69},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17996.1},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23005.93},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19690.6},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20715.9},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17865.95},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28580.6},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32151.33},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":22777.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34519.95},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17937.16},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21494.78},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18996.84},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26162.87},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18996.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11491.59,"maximum":22203.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11673.24},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19291.65},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11575.31},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14797.69},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12665.23},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13324.72},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11491.59},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18383.38},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20680.12},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14650.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22203.65},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11537.4},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13825.7},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12219.0},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16828.27},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12219.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25557.08,"maximum":49380.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25961.07},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42904.27},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25743.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32909.78},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28167.23},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29633.91},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25557.08},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40884.29},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45992.2},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32583.08},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49380.48},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25658.95},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30748.09},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27174.81},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37425.75},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27174.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22504.96,"maximum":81583.93,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":62172.45},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":42891.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70884.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24080.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":42531.71},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":39992.46},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":54371.87},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":46536.47},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":48959.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23180.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23180.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":42224.1},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":67546.95},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":75985.97},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":53832.1},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81583.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24080.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":59131.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24080.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23630.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42392.42},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22504.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22842.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23630.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50800.44},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23855.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":44896.84},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22504.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61832.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23630.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":44896.84},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":51568.54},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22504.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24080.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23481.03,"10th_percentile":23481.03,"90th_percentile":23481.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9472.58,"maximum":32830.36,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":25018.95},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17260.08},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28524.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10135.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17115.28},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16093.45},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21879.9},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18726.84},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19701.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9756.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9756.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16991.49},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27181.71},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30577.68},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21662.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32830.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10135.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23795.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10135.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9946.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17059.22},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9472.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9614.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9946.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20442.71},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10040.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18067.03},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9472.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24882.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9946.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18067.03},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20751.81},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9472.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10135.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12153.15,"maximum":42858.27,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":32660.89},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22532.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37237.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":12760.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26686.86},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12882.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23585.54},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12153.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32482.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12760.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23585.54},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27090.37},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12153.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13003.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19423.09,"maximum":70054.78,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":53386.47},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":36830.28},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60867.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20782.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":36521.29},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":34340.87},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46688.24},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":39960.11},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":42040.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20005.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20005.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":36257.15},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":58001.46},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":65247.91},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":46224.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70054.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":20394.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":43621.51},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20588.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38552.18},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19423.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53094.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20394.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":38552.18},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":44281.06},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19423.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20782.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7239.14,"maximum":24475.18,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":18651.73},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12867.47},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21265.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":7601.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15240.13},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7673.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13469.05},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7239.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18549.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7601.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13469.05},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15470.56},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7239.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7745.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10532.18,"maximum":36794.29,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":28039.73},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19344.06},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31968.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11269.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19181.77},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18036.57},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24521.68},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20987.92},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22080.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10848.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10848.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19043.04},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30463.63},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34269.62},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24278.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36794.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":11058.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22910.96},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11164.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20248.44},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10532.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27886.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11058.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20248.44},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23257.38},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10532.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11269.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17947.91,"maximum":64536.2,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":49180.93},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33928.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56072.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19204.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":33644.31},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31635.66},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43010.36},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":36812.24},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":38729.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18486.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18486.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33400.98},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":53432.39},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60107.99},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":42583.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64536.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19204.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":46775.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19204.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18845.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33534.12},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17947.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18217.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18845.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40185.21},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19024.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35515.23},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17947.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48912.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18845.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":35515.23},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":40792.81},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17947.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19204.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35235.81,"10th_percentile":35235.81,"90th_percentile":35235.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9610.85,"maximum":33347.64,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":25413.15},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17532.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28974.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10283.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17384.95},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16347.02},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22224.64},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19021.9},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20012.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9899.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9899.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17259.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27609.99},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31059.46},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":22004.01},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33347.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10283.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":24170.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10283.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10091.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17328.01},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9610.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9755.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10091.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20764.81},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10187.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18351.7},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9610.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25274.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10091.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18351.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21078.77},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9610.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10283.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":17674.44,"10th_percentile":17674.44,"90th_percentile":17674.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12004.36,"maximum":42301.63,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":32236.69},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22239.47},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36753.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12844.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22052.88},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20736.27},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28192.06},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24129.37},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25385.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12364.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12364.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21893.39},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35023.4},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39399.06},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27912.19},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42301.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12844.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30659.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12844.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12604.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21980.66},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12004.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12184.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12604.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26340.26},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12724.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23279.21},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12004.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32060.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12604.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23279.21},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26738.52},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12004.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12844.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20106.2,"maximum":72610.26,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":55333.91},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":38173.78},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63087.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21513.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37853.52},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":35593.57},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":48391.34},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":41417.78},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":43574.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20709.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20709.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":37579.74},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":60117.25},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":67628.04},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":47910.94},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72610.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21513.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":52627.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21513.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21111.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37729.54},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20106.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20407.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21111.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":45212.74},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21312.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39958.5},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20106.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55031.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21111.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":39958.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":45896.36},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20106.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21513.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12232.06,"maximum":43153.46,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":32885.84},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22687.3},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37493.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13088.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22496.96},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21153.84},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28759.76},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24615.26},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25896.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12599.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12599.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22334.25},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35728.66},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40192.44},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28474.25},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43153.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13088.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31277.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13088.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12843.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22423.28},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12232.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12843.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26870.67},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12965.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23747.99},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12232.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32706.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12843.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23747.99},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27276.95},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12232.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13088.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16543.37,"maximum":59281.88,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":45176.79},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31166.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51507.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17701.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30905.11},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":29059.99},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39508.6},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33815.11},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35575.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17039.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17039.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30681.59},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49082.1},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55214.2},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":39116.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59281.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17701.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":42966.87},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17701.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17370.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30803.89},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16543.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16791.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17370.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36913.47},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17535.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32623.7},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16543.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44930.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17370.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32623.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":37471.6},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16543.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17701.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":39508.6,"10th_percentile":39508.6,"90th_percentile":39508.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27531.7,"maximum":100388.71,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":76502.96},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":52777.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87222.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29458.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":52335.11},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":49210.57},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":66904.38},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":57262.95},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":60244.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28357.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":28357.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":51956.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":83116.27},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":93500.45},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":66240.2},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100388.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29458.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":72760.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29458.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28908.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52163.71},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27531.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27944.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28908.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":62509.75},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29183.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":55245.39},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27531.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76085.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28908.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":55245.39},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":63454.89},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27531.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29458.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13005.35,"maximum":46046.28,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":35090.37},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24208.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40007.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13915.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24005.06},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22571.9},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30687.69},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26265.36},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27633.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13395.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13395.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23831.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38123.76},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42886.77},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30383.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46046.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13915.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33373.85},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13915.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13655.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23926.44},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13005.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13200.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13655.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28671.96},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13785.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25339.95},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13005.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34898.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13655.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25339.95},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29105.48},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13005.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13915.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18298.11,"maximum":65846.27,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":50179.29},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":34617.72},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57210.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19578.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":34327.28},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":32277.86},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43883.46},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":37559.52},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":39515.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18847.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18847.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":34079.01},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54517.05},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":61328.16},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":43447.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65846.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19578.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":47724.67},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19578.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19213.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34214.86},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18298.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18572.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19213.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":41000.96},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19396.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36236.18},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18298.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49905.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19213.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":36236.18},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":41620.89},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18298.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19578.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27905.94,"maximum":101788.74,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":77569.88},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":53513.95},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88439.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29859.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":53064.98},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":49896.87},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":67837.44},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":58061.55},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":61084.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28743.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":28743.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":52681.19},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":84275.41},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":94804.41},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":67163.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101788.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29859.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":73775.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29859.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29301.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52891.19},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27905.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28324.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29301.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":63381.51},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29580.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":56015.85},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27905.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77146.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29301.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":56015.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":64339.84},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27905.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29859.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13343.52,"maximum":47311.37,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":36054.45},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24873.26},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41106.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14277.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24664.58},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23192.04},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31530.81},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26986.98},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28392.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13743.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13743.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24486.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39171.18},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44065.05},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31217.8},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47311.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14277.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":34290.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14277.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14010.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24583.8},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13343.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13543.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14010.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29459.7},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14144.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26036.15},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13343.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35857.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14010.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26036.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29905.13},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13343.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14277.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":31056.22,"10th_percentile":31056.22,"90th_percentile":31056.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13351.24,"10th_percentile":13351.24,"90th_percentile":13351.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18711.43,"maximum":67392.48,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":51357.61},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":35430.62},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58554.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20021.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35133.36},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":33035.81},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":44913.94},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":38441.5},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":40443.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19272.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19272.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":34879.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":55797.23},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62768.28},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":44468.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67392.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20021.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":48845.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20021.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19647.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35018.3},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18711.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18992.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19647.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":41963.75},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19834.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":37087.08},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18711.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51077.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19647.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":37087.08},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":42598.24},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18711.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20021.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":44929.62,"10th_percentile":44929.62,"90th_percentile":44929.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17639.22,"10th_percentile":17639.22,"90th_percentile":18713.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35239.0,"maximum":129221.4,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":98475.42},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":67936.27},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":112274.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37705.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":67366.3},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":63344.37},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":86120.02},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":73709.47},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":77547.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36296.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":36296.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":66879.08},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":106988.13},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":120354.76},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":85265.08},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129221.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37705.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":93658.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37705.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37000.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67145.67},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35239.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35767.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37000.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":80463.2},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37353.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":71112.45},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35239.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97937.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37000.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":71112.45},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":81679.81},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35239.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37705.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":81612.95,"10th_percentile":81612.95,"90th_percentile":81612.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36814.32,"10th_percentile":36814.32,"90th_percentile":36814.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12737.81,"maximum":45045.46,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":34327.68},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23681.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39137.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13629.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23483.31},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22081.3},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30020.69},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25694.48},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27032.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13119.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13119.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23313.47},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37295.13},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41954.62},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29722.67},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45045.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13629.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":32648.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13629.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13374.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23406.4},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12737.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12928.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13374.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28048.77},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13502.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24789.18},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12737.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34140.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13374.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24789.18},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28472.87},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12737.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13629.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19064.63,"maximum":68713.79,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":52364.54},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":36125.28},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59702.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20399.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":44180.52,"10th_percentile":44180.52,"90th_percentile":44180.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":8765.56,"10th_percentile":8765.56,"90th_percentile":8765.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38176.59,"maximum":140210.78,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":106850.06},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":73713.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":121822.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40848.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":73095.33},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":68731.36},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":93443.93},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":79977.95},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":84142.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39321.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":39321.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":72566.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":116086.72},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":130590.08},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":92516.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":140210.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40848.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":101623.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40848.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40085.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72855.94},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38176.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38749.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40085.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":87306.03},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40467.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":77160.07},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38176.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":106266.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40085.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":77160.07},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":88626.1},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38176.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40848.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24822.57,"maximum":90253.98,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":68779.61},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47449.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78417.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26560.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":47051.62},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":44242.52},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":60150.05},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":51481.97},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":54162.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25567.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25567.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":46711.32},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":74725.27},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":84061.11},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":59552.92},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90253.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26560.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":65415.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26560.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26063.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46897.52},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24822.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25194.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26063.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":56199.08},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26311.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":49668.1},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24822.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68403.99},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26063.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":49668.1},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":57048.81},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24822.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26560.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24376.18,"maximum":88584.06,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":67507.02},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":46571.78},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76966.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26082.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":46181.06},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":43423.93},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":59037.14},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":50529.44},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":53160.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25107.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25107.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":45847.05},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":73342.68},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":82505.78},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":58451.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88584.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26082.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":64204.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26082.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25594.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46029.81},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24376.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24741.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25594.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":55159.26},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25838.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":48749.12},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24376.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67138.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25594.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":48749.12},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":55993.27},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24376.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26082.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25433.08,"10th_percentile":25433.08,"90th_percentile":25433.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24374.7,"10th_percentile":24374.7,"90th_percentile":24374.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33216.74,"maximum":121656.2,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":92710.22},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":63958.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105701.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35541.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":63422.37},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":59635.9},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":81078.17},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":69394.19},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":73007.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34213.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":34213.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":62963.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":100724.56},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":113308.64},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":80273.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":121656.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35541.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":88175.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35541.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34877.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63214.66},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33216.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33714.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34877.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":75752.52},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35209.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":66949.21},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33216.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92203.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34877.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":66949.21},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":76897.9},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33216.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35541.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13945.46,"maximum":49563.22,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":37770.51},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26057.14},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43063.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14921.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25838.53},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24295.9},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33031.57},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28271.47},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29743.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14363.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14363.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25651.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41035.59},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46162.39},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32703.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49563.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14921.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35922.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14921.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14642.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25753.9},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13945.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14154.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14642.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30861.88},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14782.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27275.37},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13945.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37564.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14642.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27275.37},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31328.51},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13945.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14921.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":26057.14,"10th_percentile":26057.14,"90th_percentile":26057.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14557.21,"10th_percentile":14557.21,"90th_percentile":14557.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":31281.53,"10th_percentile":31281.53,"90th_percentile":31281.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14063.59,"10th_percentile":14063.59,"90th_percentile":14063.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13957.83,"10th_percentile":13957.83,"90th_percentile":13957.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":8222.59,"10th_percentile":8222.59,"90th_percentile":8222.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"1 through 10","median_amount":37564.24,"10th_percentile":37564.24,"90th_percentile":37564.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14571.13,"10th_percentile":14571.13,"90th_percentile":14571.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21143.26,"maximum":76489.85,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":58290.42},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":40213.42},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66458.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22623.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":39876.04},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":37495.34},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":50976.91},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":43630.75},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":45902.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21777.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21777.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":39587.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":63329.34},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":71241.43},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":50470.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76489.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22623.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":55439.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22623.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22200.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39745.45},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21143.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21460.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22200.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":47628.47},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22411.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":42093.5},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21143.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57972.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22200.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":42093.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":48348.62},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21143.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22623.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":25000.0,"10th_percentile":25000.0,"90th_percentile":25000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":12228.88,"10th_percentile":12228.88,"90th_percentile":12228.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21154.16,"10th_percentile":21154.16,"90th_percentile":21154.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"1 through 10","median_amount":47628.47,"10th_percentile":47628.47,"90th_percentile":47628.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"1 through 10","median_amount":57972.09,"10th_percentile":57972.09,"90th_percentile":57972.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19815.53,"10th_percentile":19815.53,"90th_percentile":19822.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18772.3,"maximum":67620.2,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":51531.15},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":35550.33},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58751.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20086.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35252.08},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":33147.44},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":45065.7},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":38571.39},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":40579.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19335.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19335.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":34997.12},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":55985.76},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62980.38},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":44618.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67620.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20086.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":49010.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20086.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19710.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35136.62},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18772.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19053.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19710.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":42105.55},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19898.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":37212.4},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18772.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51249.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19710.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":37212.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":42742.18},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18772.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20086.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34235.01,"maximum":125465.51,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":95613.17},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":65961.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":109010.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36631.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":65408.26},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":61503.22},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":83616.89},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":71567.06},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":75293.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35262.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":35262.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":64935.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":103878.46},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":116856.57},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":82786.8},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125465.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36631.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":90936.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36631.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35946.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65194.04},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34235.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34748.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35946.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":78124.49},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36289.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":69045.53},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34235.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95091.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35946.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":69045.53},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":79305.73},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34235.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36631.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18899.3,"maximum":68095.31,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":51893.21},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":35800.12},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59164.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20222.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50945.2,"maximum":187977.57,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":143251.58},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":98826.47},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":163324.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54511.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5822.58,"maximum":19175.88,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":14613.31},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10081.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16660.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6230.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":9996.86},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9400.02},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":12779.83},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10938.16},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11507.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5997.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9924.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":15876.56},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17860.11},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12652.96},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19175.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6230.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13898.47},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6230.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6113.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9964.12},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5822.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5909.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6113.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11940.38},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6171.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10552.77},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5822.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14533.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6113.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10552.77},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12120.92},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5822.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6230.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7935.78,"maximum":27081.25,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":20637.74},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14237.57},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23529.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8491.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14118.12},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13275.24},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18048.39},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15447.48},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16251.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8173.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8173.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14016.02},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22421.77},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25223.05},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17869.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27081.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8491.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19628.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8491.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8332.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14071.89},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7935.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8054.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8332.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16862.87},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8411.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14903.21},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7935.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20525.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8332.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14903.21},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17117.84},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7935.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8491.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7943.82,"10th_percentile":7943.82,"90th_percentile":7943.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8127.58,"10th_percentile":8127.58,"90th_percentile":8127.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16366.77,"maximum":58621.23,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":44673.32},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30819.26},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50933.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17512.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30560.69},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28736.14},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39068.31},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33438.27},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35179.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16857.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16857.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30339.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48535.12},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54598.88},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38680.46},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58621.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17512.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":42488.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17512.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17185.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30460.6},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16366.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16612.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17185.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36502.09},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17348.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32260.13},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16366.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44429.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17185.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32260.13},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":37054.0},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16366.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17512.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17077.63,"10th_percentile":17077.63,"90th_percentile":17077.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16365.11,"10th_percentile":16365.11,"90th_percentile":16365.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6107.4,"maximum":20241.36,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":15425.28},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10641.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17586.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6534.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":10552.32},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9922.32},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":13489.92},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11545.92},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12147.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6290.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6290.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10476.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16758.72},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18852.48},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13356.0},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20241.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6534.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14670.72},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6534.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6412.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10517.76},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6107.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6199.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6412.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12603.83},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6473.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11139.12},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6107.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15341.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6412.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11139.12},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12794.4},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6107.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6534.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":35934.33,"10th_percentile":35934.33,"90th_percentile":35934.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":20241.36,"10th_percentile":20241.36,"90th_percentile":20241.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6505.12,"10th_percentile":6505.12,"90th_percentile":6505.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6109.03,"10th_percentile":6109.03,"90th_percentile":6110.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3303.45,"10th_percentile":3303.45,"90th_percentile":3303.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4604.56,"10th_percentile":4604.56,"90th_percentile":4604.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7246.66,"maximum":24503.29,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":18673.16},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12882.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21289.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7753.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12774.17},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12011.52},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16330.3},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13976.98},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14704.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7464.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7464.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12681.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20287.36},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22821.97},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16168.18},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24503.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7753.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17759.72},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7753.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7608.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12732.33},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7246.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7355.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7608.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15257.64},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7681.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13484.52},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7246.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18571.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7608.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13484.52},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15488.33},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7246.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7753.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7563.5,"10th_percentile":7563.5,"90th_percentile":7563.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":24503.29,"10th_percentile":24503.29,"90th_percentile":24503.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6803.92,"10th_percentile":6803.92,"90th_percentile":6803.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2988.01,"10th_percentile":2988.01,"90th_percentile":2988.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2988.01,"10th_percentile":2988.01,"90th_percentile":2988.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36503.12,"10th_percentile":36503.12,"90th_percentile":36503.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5971.38,"maximum":19732.51,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":15037.51},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10374.08},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17144.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6389.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":10287.05},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9672.88},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":13150.8},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11255.67},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11841.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6150.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6150.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10212.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16337.42},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18378.55},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13020.25},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19732.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6389.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14301.91},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6389.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6269.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10253.36},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5971.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6060.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6269.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12286.98},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6329.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10859.09},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5971.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14955.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6269.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10859.09},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12472.76},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5971.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6389.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4950.85,"maximum":15914.77,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":12128.13},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":8366.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13827.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5297.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":8296.76},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":7801.42},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":10606.45},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":9077.98},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":9550.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5099.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5099.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":8236.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":13176.54},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14822.76},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":10501.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15914.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5297.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":11534.85},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5297.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5198.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8269.59},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4950.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5025.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5198.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9909.76},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5247.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":8758.13},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4950.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12061.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5198.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":8758.13},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":10059.6},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4950.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5297.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":8523.24,"10th_percentile":8523.24,"90th_percentile":8523.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4540.76,"10th_percentile":4540.76,"90th_percentile":4540.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7901.96,"maximum":26954.74,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":20541.33},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14171.06},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23419.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8455.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14052.17},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13213.22},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17964.08},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15375.32},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16175.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8139.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8139.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13950.54},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22317.03},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25105.22},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17785.74},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26954.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8455.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19536.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8455.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8297.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14006.15},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7901.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8020.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8297.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16784.1},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8376.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14833.59},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7901.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20429.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8297.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14833.59},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17037.88},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7901.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8455.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":18915.0,"10th_percentile":18915.0,"90th_percentile":18915.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":15785.05,"10th_percentile":15785.05,"90th_percentile":15785.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":16028.0,"10th_percentile":16028.0,"90th_percentile":16028.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2210.49,"10th_percentile":2210.49,"90th_percentile":2210.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3244.65,"10th_percentile":3244.65,"90th_percentile":3244.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"1 through 10","median_amount":15056.0,"10th_percentile":15056.0,"90th_percentile":15056.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4146.29,"10th_percentile":4146.29,"90th_percentile":4146.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14240.05,"maximum":50665.25,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":38610.33},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26636.52},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44020.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15236.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26413.04},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24836.12},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33766.02},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28900.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30404.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14667.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14667.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26222.01},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41948.01},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47188.8},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33430.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50665.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15236.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":36721.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15236.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14952.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26326.54},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14240.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14453.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14952.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31548.09},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15094.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27881.84},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14240.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38399.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14952.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27881.84},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32025.09},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14240.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15236.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":972.71,"10th_percentile":972.71,"90th_percentile":972.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45361.61,"maximum":167089.62,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":127333.54},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":87844.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145175.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48536.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":87107.94},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":81907.37},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":111357.42},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":95309.97},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":100272.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46722.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":46722.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":86477.93},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":138340.91},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":155624.6},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":110251.93},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":167089.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48536.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":121104.76},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48536.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47629.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86822.65},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45361.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46042.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47629.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":104042.87},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48083.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":91951.89},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45361.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":126638.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47629.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":91951.89},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":105616.0},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45361.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48536.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":7083.08,"10th_percentile":7083.08,"90th_percentile":7083.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31199.73,"maximum":114110.67,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":86960.02},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":59992.02},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99145.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33383.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":59488.7},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":55937.08},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":76049.42},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":65090.12},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":68479.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32135.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":32135.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":59058.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":94477.28},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":106280.86},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":75294.45},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114110.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33383.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":82706.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33383.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32759.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59293.87},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31199.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31667.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32759.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":71054.09},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33071.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":62796.79},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31199.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86485.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32759.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":62796.79},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":72128.43},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31199.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33383.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":7729.78,"10th_percentile":7729.78,"90th_percentile":7729.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19102.2,"maximum":68854.36,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":52471.66},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":36199.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59824.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20439.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35895.48},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":33752.43},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":45888.21},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":39275.37},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":41320.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19675.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19675.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":35635.86},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":57007.58},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64129.85},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":45432.66},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68854.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20439.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":49904.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20439.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20057.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35777.91},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19102.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19388.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20057.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":42874.03},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20248.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":37891.57},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19102.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52185.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20057.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":37891.57},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":43522.28},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19102.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20439.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":867.91,"10th_percentile":867.91,"90th_percentile":867.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32030.88,"maximum":117219.96,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":89329.51},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":61626.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101846.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34273.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":61109.66},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":57461.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":78121.63},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":66863.71},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":70345.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32991.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":32991.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":60667.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":97051.61},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":109176.81},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":77346.08},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":117219.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34273.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":84959.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34273.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33632.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60909.52},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32030.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32511.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33632.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":72990.18},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33952.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":64507.88},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32030.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88841.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33632.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":64507.88},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":74093.79},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32030.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34273.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":4122.84,"10th_percentile":4122.84,"90th_percentile":4122.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":935.64,"10th_percentile":935.64,"90th_percentile":935.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":926.81,"10th_percentile":926.81,"90th_percentile":926.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":7083.08,"10th_percentile":7083.08,"90th_percentile":7083.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11787.93,"maximum":41491.98,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":31619.68},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21813.8},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36050.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12613.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21630.79},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20339.38},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27652.46},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23667.53},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24899.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12141.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12141.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21474.35},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34353.05},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38644.97},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27377.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41491.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12613.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30072.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12613.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12377.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21559.95},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11787.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11964.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12377.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25836.1},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12495.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22833.65},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11787.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31447.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12377.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22833.65},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26226.74},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11787.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12613.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":4170.0,"10th_percentile":4170.0,"90th_percentile":4170.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":611.36,"10th_percentile":611.36,"90th_percentile":611.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":629.16,"10th_percentile":629.16,"90th_percentile":629.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"17","median_amount":623.23,"10th_percentile":623.23,"90th_percentile":926.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"1 through 10","median_amount":4176.0,"10th_percentile":4176.0,"90th_percentile":4176.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":623.23,"10th_percentile":623.23,"90th_percentile":3021.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2198.13,"maximum":5616.98,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":4280.52},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":2953.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4880.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2352.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":2928.27},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":2753.44},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":3743.45},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":3203.99},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":3370.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2264.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":2264.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":2907.09},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":4650.54},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":5231.56},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":3706.29},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5616.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2352.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4071.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2352.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2308.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2918.68},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2198.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2231.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2308.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3497.56},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2330.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3091.11},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2198.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4257.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2308.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3091.11},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3550.45},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2198.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2352.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":629.16,"10th_percentile":629.16,"90th_percentile":629.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":623.23,"10th_percentile":623.23,"90th_percentile":623.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":623.23,"10th_percentile":623.23,"90th_percentile":623.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6225.38,"maximum":20682.73,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":15761.64},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10873.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17970.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6661.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":10782.42},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10138.68},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":13784.08},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11797.69},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12411.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6412.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6412.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10704.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17124.15},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19263.57},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13647.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20682.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6661.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14990.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6661.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6536.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10747.11},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6225.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6318.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6536.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12878.66},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6598.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11382.01},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6225.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15675.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6536.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11382.01},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13073.39},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6225.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6661.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":17124.15,"10th_percentile":17124.15,"90th_percentile":17124.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6226.97,"10th_percentile":5845.57,"90th_percentile":6230.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9744.62,"maximum":33848.05,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":25794.5},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17795.12},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29408.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10426.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17645.82},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16592.32},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22558.14},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19307.34},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20312.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10036.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10036.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17518.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28024.3},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31525.54},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":22334.2},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33848.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10426.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":24532.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10426.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10231.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17588.03},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9744.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9890.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10231.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21076.41},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10329.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18627.08},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9744.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25653.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10231.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18627.08},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21395.08},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9744.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10426.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1574.74,"10th_percentile":1574.74,"90th_percentile":1574.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":33848.05,"10th_percentile":33848.05,"90th_percentile":33848.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9240.73,"10th_percentile":9240.73,"90th_percentile":9240.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7559.28,"maximum":25672.79,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":19564.4},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13497.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22305.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8088.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":13383.86},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12584.81},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17109.72},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14644.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15406.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7786.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7786.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13287.06},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21255.64},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23911.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16939.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25672.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8088.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18607.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8088.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7937.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13340.03},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7559.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7672.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7937.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15985.86},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8012.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14128.12},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7559.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19457.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7937.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14128.12},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16227.56},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7559.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8088.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7025.89,"10th_percentile":7025.89,"90th_percentile":7025.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12538.67,"maximum":44300.47,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":33759.94},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23290.32},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38490.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13416.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23094.92},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21716.1},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29524.19},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25269.53},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26585.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12914.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12914.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22927.89},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36678.32},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41260.75},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29231.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44300.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13416.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":32108.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13416.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13165.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23019.29},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12538.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12726.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13165.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27584.88},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13290.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24379.2},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12538.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33575.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13165.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24379.2},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28001.97},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12538.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13416.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6371.17,"maximum":21228.13,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":16177.26},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11160.38},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18444.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6817.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11066.75},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10406.03},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14147.55},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12108.78},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12739.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6562.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6562.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10986.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17575.71},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19771.54},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14007.11},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21228.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6817.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15385.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6817.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6689.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11030.5},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6371.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6466.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6689.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13218.27},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6753.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11682.15},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6371.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16088.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6689.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11682.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13418.13},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6371.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6817.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6785.9,"10th_percentile":6785.9,"90th_percentile":6785.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6380.97,"10th_percentile":6380.97,"90th_percentile":6382.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4100.73,"10th_percentile":4100.73,"90th_percentile":4100.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4693.28,"10th_percentile":4693.28,"90th_percentile":4693.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9639.41,"maximum":33454.47,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":25494.56},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17588.2},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29066.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10314.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17440.64},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16399.39},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22295.84},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19082.84},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20076.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9928.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9928.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17314.5},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27698.44},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31158.96},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":22074.5},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33454.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10314.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":24247.44},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10314.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10121.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17383.52},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9639.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9784.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10121.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20831.33},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10217.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18410.49},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9639.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25355.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10121.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18410.49},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21146.3},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9639.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10314.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":27682.97,"10th_percentile":27682.97,"90th_percentile":27682.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":19082.84,"10th_percentile":19082.84,"90th_percentile":19082.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9639.91,"10th_percentile":9639.91,"90th_percentile":9639.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8220.29,"10th_percentile":8220.29,"90th_percentile":8220.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5755.7,"maximum":18925.67,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":14422.64},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9949.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16443.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6158.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":9866.42},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9277.37},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":12613.08},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10795.44},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11357.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5928.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5928.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9795.06},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":15669.4},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17627.07},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12487.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18925.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6158.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13717.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6158.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9834.11},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5755.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5842.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11784.58},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6101.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10415.08},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5755.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14343.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6043.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10415.08},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":11962.76},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5755.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6158.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":15669.4,"10th_percentile":15669.4,"90th_percentile":15669.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9689.01,"maximum":33640.02,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":25635.96},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17685.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29228.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10367.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17537.37},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16490.34},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22419.5},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19188.68},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20187.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9979.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9979.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17410.53},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27852.06},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31331.77},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":22196.93},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33640.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10367.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":24381.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10367.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10173.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17479.93},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9689.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9834.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10173.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20946.87},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10270.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18512.6},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9689.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25495.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10173.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18512.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21263.58},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9689.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10367.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6105.14,"maximum":20232.93,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":15418.85},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10637.17},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17579.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6532.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":10547.92},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9918.19},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":13484.3},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11541.11},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12142.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6288.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6288.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10471.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16751.74},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18844.62},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13350.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20232.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6532.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14664.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6532.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6410.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10513.38},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6105.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6196.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6410.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12598.58},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6471.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11134.48},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6105.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15334.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6410.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11134.48},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12789.07},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6105.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6532.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6106.77,"10th_percentile":6106.77,"90th_percentile":6106.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8718.83,"maximum":30010.63,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":22870.12},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15777.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26074.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9329.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15645.28},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14711.22},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20000.68},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17118.43},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18009.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8980.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8980.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15532.13},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24847.13},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27951.42},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19802.13},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30010.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9329.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21751.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9329.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9154.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15594.04},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8718.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8849.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9154.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18686.93},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9241.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16515.29},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8718.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22745.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9154.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16515.29},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18969.48},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8718.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9329.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9284.97,"10th_percentile":9284.97,"90th_percentile":9284.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8719.62,"10th_percentile":8719.62,"90th_percentile":8719.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3098.19,"10th_percentile":3098.19,"90th_percentile":3098.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8929.19,"10th_percentile":8929.19,"90th_percentile":8929.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12966.27,"maximum":45900.1,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":34978.96},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24131.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39880.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13873.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23928.85},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22500.24},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30590.27},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26181.98},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27545.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13355.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13355.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23755.79},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38002.73},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42750.62},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30286.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45900.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13873.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33267.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13873.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13614.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23850.48},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12966.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13160.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13614.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28580.94},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13744.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25259.5},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12966.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34787.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13614.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25259.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29013.08},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12966.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13873.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":27045.28,"10th_percentile":27045.28,"90th_percentile":27045.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"1 through 10","median_amount":34787.94,"10th_percentile":34787.94,"90th_percentile":34787.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4116.69,"maximum":12794.23,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":9750.06},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":6726.38},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11116.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4404.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":6669.95},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":6271.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":8526.75},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":7297.98},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":7677.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4240.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":4240.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":6621.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":10592.91},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":11916.34},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":8442.11},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12794.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4404.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":9273.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4404.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4322.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6648.1},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4116.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4178.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4322.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7966.67},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4363.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":7040.85},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4116.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9696.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4322.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":7040.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":8087.13},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4116.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4404.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5461.11,"maximum":17823.64,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":13582.82},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9370.52},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15486.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5843.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":9291.9},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":8737.15},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":11878.62},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10166.82},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":10696.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5624.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5624.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9224.7},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":14756.98},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16600.66},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11760.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17823.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5843.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12918.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5843.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5734.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9261.47},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5461.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5543.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5734.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11098.37},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5788.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":9808.61},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5461.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13508.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5734.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":9808.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":11266.18},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5461.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5843.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12434.21,"maximum":43909.69,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":33462.15},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23084.88},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38150.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13304.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4950.1,"maximum":15911.96,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":12125.98},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":8365.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13825.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5296.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":8295.3},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":7800.05},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":10604.58},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":9076.38},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":9548.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5098.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5098.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":8235.3},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":13174.22},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14820.14},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":10499.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15911.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5296.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":11532.82},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5296.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5197.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8268.13},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4950.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5024.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5197.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9908.01},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5247.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":8756.59},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4950.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12059.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5197.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":8756.59},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":10057.82},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4950.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5296.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7076.82,"maximum":23867.94,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":18188.98},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12548.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20737.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7572.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12442.94},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11700.07},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15906.86},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13614.56},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14323.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7289.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7289.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12352.95},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19761.32},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22230.22},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15748.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23867.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7572.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17299.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7572.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7430.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12402.19},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7076.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7182.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7430.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14862.02},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7501.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13134.88},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7076.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18089.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7430.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13134.88},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15086.73},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7076.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7572.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10344.31,"maximum":36091.47,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":27504.13},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18974.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31358.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11068.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18815.37},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17692.05},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24053.28},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20587.02},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21658.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10654.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10654.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18679.29},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29881.73},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33615.02},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":23814.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36091.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11068.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26158.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11068.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10861.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18753.75},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10344.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10499.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10861.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22473.33},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10964.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19861.67},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10344.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27353.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10861.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19861.67},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22813.13},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10344.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11068.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10794.99,"10th_percentile":8686.4,"90th_percentile":10816.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":21658.99,"10th_percentile":21658.99,"90th_percentile":21658.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10603.51,"10th_percentile":10603.51,"90th_percentile":10603.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":10344.6,"10th_percentile":9951.59,"90th_percentile":10358.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9044.81,"10th_percentile":6862.92,"90th_percentile":10809.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7683.28,"maximum":26136.66,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":19917.89},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13740.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22708.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8221.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":13625.68},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12812.2},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17418.86},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14908.67},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15684.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7913.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7913.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13527.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21639.7},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24343.26},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17245.94},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26136.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8221.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18943.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8221.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8067.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13581.06},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7683.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7798.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8067.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16274.7},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8144.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14383.39},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7683.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19809.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8067.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14383.39},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16520.77},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7683.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8221.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13523.88,"maximum":47986.08,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":36568.63},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25227.98},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41692.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14470.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25016.33},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23522.79},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31980.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27371.85},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28797.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13929.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13929.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24835.4},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39729.8},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44693.47},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31663.0},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47986.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":14200.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29879.83},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14335.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26407.45},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13523.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36368.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14200.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26407.45},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30331.61},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13523.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14470.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21033.54,"maximum":76079.4,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":57977.63},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":39997.64},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66101.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22505.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":39662.07},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":37294.14},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":50703.36},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":43396.62},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":45656.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21664.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21664.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":39375.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":62989.51},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":70859.14},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":50200.01},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76079.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":22085.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":47372.9},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22295.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41867.62},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21033.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57661.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22085.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":41867.62},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":48089.17},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21033.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22505.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8738.37,"maximum":30083.72,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":22925.82},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15816.08},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26138.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9350.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15683.39},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14747.05},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20049.39},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17160.12},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18053.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9000.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9000.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15569.96},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24907.65},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28019.5},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19850.36},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30083.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9350.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21804.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9350.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9175.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15632.02},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8738.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8869.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9175.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18732.44},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9262.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16555.52},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8738.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22800.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9175.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16555.52},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19015.68},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8738.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9350.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":20049.39,"10th_percentile":20049.39,"90th_percentile":23478.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9305.78,"10th_percentile":9305.78,"90th_percentile":9305.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8739.17,"10th_percentile":8739.17,"90th_percentile":8739.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4736.9,"10th_percentile":4736.9,"90th_percentile":4736.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7116.6,"10th_percentile":7116.6,"90th_percentile":9131.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17325.68,"maximum":62208.45,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":47407.03},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32705.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54049.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18538.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":32430.8},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30494.6},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41459.02},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":35484.46},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":37332.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17845.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17845.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":32196.24},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":51505.13},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":57939.96},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":41047.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62208.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18538.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":45088.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18538.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18191.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32324.58},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17325.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17585.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18191.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38735.77},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18365.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34234.23},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17325.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47148.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18191.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":34234.23},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":39321.46},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17325.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18538.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18094.47,"10th_percentile":18094.47,"90th_percentile":18094.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18446.91,"10th_percentile":18446.91,"90th_percentile":18446.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17333.71,"10th_percentile":17333.71,"90th_percentile":17333.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"1 through 10","median_amount":47148.13,"10th_percentile":47148.13,"90th_percentile":47148.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16191.67,"10th_percentile":16191.67,"90th_percentile":16191.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5197.34,"maximum":16836.88,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":12830.83},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":8851.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14628.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5561.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":8777.48},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":8253.44},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":11220.99},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":9603.96},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":10104.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5353.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5353.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":8714.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":13940.0},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15681.6},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11109.6},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16836.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5561.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12203.19},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5561.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5457.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8748.73},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5197.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5275.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5457.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10483.94},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5509.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":9265.58},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5197.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12760.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5457.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":9265.58},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":10642.45},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5197.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5561.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5898.48,"maximum":19459.82,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":14829.69},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10230.72},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16907.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6311.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":10144.88},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9539.21},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":12969.06},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11100.12},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11678.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6075.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6075.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10071.51},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16111.65},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18124.56},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12840.31},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19459.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6311.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14104.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6311.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6193.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10111.66},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5898.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5986.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6193.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12117.18},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6252.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10709.03},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5898.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14748.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6193.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10709.03},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12300.39},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5898.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6311.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15582.21,"maximum":55686.23,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":42436.66},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29276.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48383.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16672.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":29030.6},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27297.4},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37112.27},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31764.11},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33418.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16049.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16049.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28820.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46105.1},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51865.27},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":36743.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55686.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16672.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":40360.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16672.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16361.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28935.53},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15582.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15815.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16361.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34674.54},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16517.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30644.96},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15582.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42204.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16361.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30644.96},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35198.82},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15582.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16672.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6130.69,"maximum":20328.51,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":15491.69},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10687.42},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17662.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6559.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14733.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6559.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6437.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10563.04},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6130.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6222.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6437.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12658.1},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6498.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11187.08},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6130.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15407.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6437.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11187.08},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12849.49},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6130.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6559.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":10687.42,"10th_percentile":10687.42,"90th_percentile":10687.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7603.62,"maximum":25838.66,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":19690.8},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13584.3},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22449.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8135.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":13470.33},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12666.12},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17220.26},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14738.69},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15506.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7831.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7831.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13372.91},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21392.97},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24065.71},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17049.31},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25838.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8135.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18727.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8135.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7983.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13426.21},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7603.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7717.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7983.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16089.14},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8059.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14219.4},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7603.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19583.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7983.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14219.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16332.41},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7603.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8135.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":15506.14,"10th_percentile":14338.69,"90th_percentile":17220.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7795.11,"10th_percentile":7795.11,"90th_percentile":7795.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8097.83,"10th_percentile":8097.83,"90th_percentile":8097.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7607.77,"10th_percentile":6899.99,"90th_percentile":7608.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"1 through 10","median_amount":16089.14,"10th_percentile":16089.14,"90th_percentile":16089.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6136.24,"10th_percentile":5954.94,"90th_percentile":7787.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12751.34,"maximum":45096.06,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":34366.24},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23708.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39181.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13643.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23509.69},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22106.1},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30054.42},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25723.35},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27062.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13133.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13133.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23339.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37337.03},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42001.75},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29756.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45096.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13643.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":32685.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13643.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13388.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23432.69},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12751.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12942.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13388.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28080.28},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13516.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24817.03},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12751.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34178.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13388.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24817.03},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28504.86},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12751.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13643.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13328.0,"10th_percentile":13306.0,"90th_percentile":13331.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":25723.35,"10th_percentile":25723.35,"90th_percentile":26162.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":45096.06,"10th_percentile":45096.06,"90th_percentile":45096.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13577.55,"10th_percentile":13577.55,"90th_percentile":13577.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":5235.18,"10th_percentile":5235.18,"90th_percentile":5235.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12460.41,"10th_percentile":12460.41,"90th_percentile":12460.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"1 through 10","median_amount":28080.28,"10th_percentile":28080.28,"90th_percentile":28080.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11288.39,"10th_percentile":11224.69,"90th_percentile":13323.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27798.48,"maximum":101386.72,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":77263.51},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":53302.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88089.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29744.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":52855.4},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":49699.8},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":67569.51},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":57832.23},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":60843.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28632.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":28632.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":52473.12},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":83942.57},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":94429.98},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":66898.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101386.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29744.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":73484.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29744.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29188.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52682.29},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27798.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28215.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29188.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":63131.19},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29466.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":55794.61},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27798.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76841.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29188.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":55794.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":64085.73},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27798.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29744.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42526.23,"maximum":156482.58,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":119250.27},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":82268.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":135960.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":44652.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":97438.11},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45077.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":86114.68},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42526.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":118599.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44652.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":86114.68},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":98911.37},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42526.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45503.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35404.33,"maximum":129839.89,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":98946.74},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":68261.43},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":112811.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37882.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":67688.74},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":63647.55},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":86532.22},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":74062.27},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":77918.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36466.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":36466.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":67199.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":107500.21},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":120930.8},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":85673.18},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129839.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":37174.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":80848.32},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37528.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":71452.81},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35404.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98406.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37174.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":71452.81},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":82070.75},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35404.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37882.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":87121.98,"10th_percentile":87121.98,"90th_percentile":87121.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45835.8,"maximum":168863.55,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":128685.4},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":88777.55},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146717.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49044.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":88032.73},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":82776.95},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":112539.66},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":96321.84},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":101337.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47210.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":47210.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":87396.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":139809.62},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":157276.81},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":111422.43},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":168863.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49044.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":122390.48},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49044.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48127.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87744.41},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45835.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46523.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48127.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":105147.46},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48585.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":92928.11},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45835.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":127982.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48127.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":92928.11},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":106737.28},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45835.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49044.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45824.68,"10th_percentile":45824.68,"90th_percentile":45824.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54281.07,"maximum":200456.94,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":152761.69},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":105387.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":174167.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58080.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":104503.14},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":98264.04},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":133595.17},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":114343.09},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":120296.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55909.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":55909.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":103747.32},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":165967.19},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":186702.39},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":132268.92},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":200456.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58080.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":145289.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58080.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56995.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":104160.88},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54281.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55095.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56995.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":124819.93},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57537.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":110314.42},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54281.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":151927.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56995.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":110314.42},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":126707.21},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54281.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58080.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25433.53,"maximum":92539.56,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":70521.38},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":48651.33},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80403.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":26705.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":57622.26},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26959.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":50925.89},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25433.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70136.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26705.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":50925.89},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":58493.51},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25433.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27213.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31699.47,"maximum":115980.18,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":88384.71},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":60974.89},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100769.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":33284.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":72218.2},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33601.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":63825.61},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31699.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87902.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33284.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":63825.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":73310.14},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31699.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33918.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19882.25,"maximum":71772.49,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":54695.47},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":37733.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62359.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21274.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37416.77},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":35182.89},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47833.01},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":40939.91},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":43071.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20478.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20478.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":37146.15},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":59423.63},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":66847.75},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":47358.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71772.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21274.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":52019.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21274.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20876.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37294.22},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19882.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20180.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20876.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":44691.08},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21075.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39497.46},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19882.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54396.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20876.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":39497.46},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":45366.81},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19882.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21274.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27421.98,"maximum":99978.26,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":76190.17},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":52562.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86866.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29341.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":52121.13},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":49009.37},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":66630.84},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":57028.83},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":59998.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28244.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":28244.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":51744.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":82776.44},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":93118.16},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":65969.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99978.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":28793.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":62254.17},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29067.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":55019.52},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27421.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75774.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28793.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":55019.52},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":63195.45},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27421.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29341.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28617.37,"10th_percentile":28617.37,"90th_percentile":28617.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":57028.83,"10th_percentile":57028.83,"90th_percentile":57028.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25487.92,"10th_percentile":25487.92,"90th_percentile":25487.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40347.65,"maximum":148332.62,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":113039.45},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":77983.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128878.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43171.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":77329.45},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":72712.69},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":98856.76},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":84610.75},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":89016.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41558.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":41558.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":76770.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":122811.16},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":138154.64},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":97875.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148332.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43171.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":107509.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43171.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42365.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77076.19},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40347.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40952.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42365.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":92363.32},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42768.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":81629.64},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40347.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":112422.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42365.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":81629.64},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":93759.85},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40347.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43171.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42119.58,"10th_percentile":42119.58,"90th_percentile":42119.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39475.16,"10th_percentile":39475.16,"90th_percentile":39475.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32433.68,"maximum":118726.82,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":90477.84},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":62418.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103155.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34704.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":61895.22},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":58199.92},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":79125.88},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":67723.24},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":71249.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33406.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33406.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":61447.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":98299.2},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":110580.27},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":78340.36},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":118726.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34704.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":86051.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34704.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34055.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61692.51},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32433.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32920.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34055.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":73928.47},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34379.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":65337.13},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32433.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89983.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34055.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":65337.13},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":75046.26},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32433.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34704.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52383.55,"maximum":193358.4,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":147352.13},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":101655.36},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":167999.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56050.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36473.71,"maximum":133840.37,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":101995.38},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":70364.62},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116287.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39026.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":69774.28},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":65608.58},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":89198.35},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":76344.19},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":80319.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37567.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":37567.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":69269.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":110812.38},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":124656.79},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":88312.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":133840.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39026.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":97006.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39026.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38297.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69545.77},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36473.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37020.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38297.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":83339.33},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38662.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":73654.34},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36473.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101438.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38297.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":73654.34},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":84599.42},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36473.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39026.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34636.2,"10th_percentile":34636.2,"90th_percentile":34636.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38104.06,"10th_percentile":38104.06,"90th_percentile":38104.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46751.12,"maximum":172287.71,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":131294.84},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":90577.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":149692.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50023.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":89817.83},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":84455.48},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":114821.7},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":98275.02},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":103392.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48153.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":48153.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":89168.22},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":142644.64},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":160466.03},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":113681.82},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":172287.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50023.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":124872.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50023.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49088.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89523.67},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46751.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47452.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49088.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":107279.6},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49556.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":94812.48},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46751.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130577.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49088.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":94812.48},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":108901.67},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46751.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50023.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27887.15,"maximum":101718.46,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":77516.32},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":53477.0},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88378.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":29281.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":63337.75},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29560.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":55977.17},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27887.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77092.99},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29281.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":55977.17},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":64295.41},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27887.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29839.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25801.01,"maximum":93914.29,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":71569.01},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":49374.07},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81597.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27607.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":48959.83},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":46036.81},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":62589.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":53569.86},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":56359.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":27349.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":51682.42},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25801.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71178.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27091.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":51682.42},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":59362.46},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25801.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27607.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23672.78,"maximum":85952.69,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":65501.74},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":45188.37},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74680.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":24856.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":53520.77},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25093.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":47301.04},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23672.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65144.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24856.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":47301.04},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":54330.0},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23672.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25329.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12945.23,"maximum":45821.38,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":34918.98},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24089.92},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39811.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13851.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23887.81},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22461.65},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30537.81},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26137.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27498.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13333.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13333.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23715.05},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37937.55},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42677.3},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30234.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45821.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":13592.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28531.92},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13721.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25216.18},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12945.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34728.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13592.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25216.18},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28963.32},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12945.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13851.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14903.62,"maximum":53147.63,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":40502.07},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27941.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46177.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15946.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":27707.17},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26052.98},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35420.41},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30316.06},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":31894.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15350.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15350.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27506.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44003.28},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49500.85},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":35068.78},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53147.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15946.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":38520.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15946.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15648.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27616.42},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14903.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15127.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15648.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33093.81},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15797.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29247.93},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14903.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40280.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15648.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29247.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":33594.19},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14903.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15946.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14906.94,"10th_percentile":14906.94,"90th_percentile":14906.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25141.2,"maximum":91445.97,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":69687.99},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":48076.38},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79452.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26901.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":47673.04},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":44826.84},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":60944.46},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":52161.9},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":54877.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25895.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25895.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":47328.24},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":75712.17},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":85171.32},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":60339.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91445.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26901.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":66279.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26901.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26398.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47516.9},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25141.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25518.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26398.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":56941.3},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26649.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":50324.07},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25141.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69307.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26398.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":50324.07},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":57802.26},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25141.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26901.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15892.58,"maximum":56847.3,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":43321.47},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29886.64},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49391.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17005.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":29635.9},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27866.56},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37886.07},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":32426.4},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":34114.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29421.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":47066.4},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":52946.67},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":37509.96},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56847.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17005.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":41202.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17005.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16687.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29538.84},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15892.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16130.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16687.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35397.51},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16846.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31283.91},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15892.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43084.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16687.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31283.91},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35932.72},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15892.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17005.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24309.3,"maximum":88333.86,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":67316.35},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":46440.24},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76748.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26010.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":46050.62},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":43301.28},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":58870.39},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":50386.72},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":53010.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25038.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25038.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":45717.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":73135.52},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":82272.75},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":58285.96},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88333.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26010.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":64023.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26010.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25524.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45899.8},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24309.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24673.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25524.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":55003.47},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25767.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":48611.43},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24309.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66948.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25524.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":48611.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":55835.12},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24309.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26010.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8904.45,"maximum":30705.02,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":23399.29},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16142.72},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26678.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":9349.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19119.31},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9438.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16897.43},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8904.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23271.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9349.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16897.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19408.39},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8904.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9527.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13456.24,"maximum":47733.06,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":36375.81},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25094.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41472.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":14129.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29722.28},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14263.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26268.21},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13456.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36177.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14129.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26268.21},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30171.68},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13456.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14398.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20967.41,"maximum":75832.01,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":57789.1},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":39867.57},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65886.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22435.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":39533.09},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":37172.87},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":50538.49},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":43255.51},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":45507.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21596.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21596.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":39247.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":62784.68},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":70628.72},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":50036.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75832.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22435.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":54962.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22435.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22015.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39403.62},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20967.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21281.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22015.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":47218.85},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22225.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41731.48},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20967.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57473.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22015.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":41731.48},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":47932.8},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20967.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22435.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14085.99,"maximum":50088.93,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":38171.14},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26333.53},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43519.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15072.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26112.6},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24553.61},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33381.93},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28571.34},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30059.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14508.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14508.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25923.74},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41470.85},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46652.03},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33050.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50088.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":14790.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31189.23},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14931.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27564.68},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14085.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37962.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14790.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27564.68},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31660.81},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14085.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15072.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":9528.89,"10th_percentile":9528.89,"90th_percentile":9528.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20202.39,"maximum":72970.1,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":55608.13},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":38362.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63400.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21616.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":38041.11},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":35769.96},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":48631.16},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":41623.04},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":43790.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20808.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20808.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":37765.98},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":60415.19},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":67963.19},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":48148.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72970.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21616.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":52887.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21616.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21212.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37916.52},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20202.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20505.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21212.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":45436.81},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21414.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":40156.53},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20202.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55304.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21212.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40156.53},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":46123.81},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20202.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21616.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19475.07,"10th_percentile":19475.07,"90th_percentile":19753.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26910.96,"maximum":98066.58,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":74733.34},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":51557.07},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85205.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28794.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":51124.52},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":48072.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":65356.79},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":55938.38},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":58851.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27718.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":27718.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":50754.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":81193.67},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":91337.65},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":64707.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98066.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28794.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":71077.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28794.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28256.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50957.09},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26910.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27314.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28256.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":61063.81},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28525.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":53967.49},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26910.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74325.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28256.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":53967.49},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":61987.09},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26910.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28794.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":4564.09,"10th_percentile":4564.09,"90th_percentile":4564.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45783.47,"10th_percentile":45783.47,"90th_percentile":45783.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25984.57,"10th_percentile":25984.57,"90th_percentile":25984.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11927.71,"maximum":42014.88,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":32018.17},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22088.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36504.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12762.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21903.39},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20595.7},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28000.95},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23965.8},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25213.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12285.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12285.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21744.98},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34785.98},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39131.99},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27722.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42014.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12762.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30451.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12762.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12524.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21831.66},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11927.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12106.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12524.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26161.7},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12643.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23121.41},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11927.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31843.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12524.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23121.41},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26557.27},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11927.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12762.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12446.77,"10th_percentile":12446.77,"90th_percentile":12446.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17097.97,"maximum":61356.62,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":46757.88},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32257.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53309.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18294.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":31986.72},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30077.03},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40891.32},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":34998.57},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":36820.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17610.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17610.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":31755.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50799.87},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":57146.58},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":40485.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61356.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18294.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":44470.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18294.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17952.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31881.96},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17097.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17354.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17952.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38205.36},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18123.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33765.46},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17097.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46502.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17952.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33765.46},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":38783.03},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17097.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18294.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34982.75,"maximum":128262.75,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":97744.86},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":67432.27},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111441.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":36731.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":79866.27},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37081.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":70584.89},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34982.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97211.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36731.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":70584.89},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":81073.85},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34982.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37431.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14279.88,"maximum":50814.25,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":38723.88},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26714.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44150.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15279.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":36829.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15279.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14993.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26403.96},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14279.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14494.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14993.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31640.87},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15136.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27963.83},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14279.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38512.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14993.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27963.83},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32119.28},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14279.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15279.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16710.2,"maximum":59905.99,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":45652.4},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31494.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52049.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17879.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":31230.47},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":29365.93},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39924.54},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":34171.11},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35950.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17211.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17211.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":31004.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49598.83},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55795.49},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":39528.2},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59905.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17879.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":43419.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17879.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17545.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31128.19},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16710.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16960.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17545.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37302.09},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17712.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32967.15},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16710.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45403.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17545.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32967.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":37866.09},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16710.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17879.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15386.62,"10th_percentile":15386.62,"90th_percentile":15386.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16710.44,"10th_percentile":16710.44,"90th_percentile":16713.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24690.3,"maximum":89759.19,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":68402.55},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47189.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77987.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26418.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":46793.68},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":43999.98},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":59820.3},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":51199.74},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":53865.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25431.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25431.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":46455.24},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":74315.61},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":83600.28},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":59226.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89759.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26418.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":65056.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26418.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25924.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46640.42},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24690.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25060.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25924.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":55890.99},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26171.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":49395.81},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24690.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68028.99},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25924.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":49395.81},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":56736.06},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24690.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26418.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11100.31,"maximum":38919.64,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":29659.39},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20461.43},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33815.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11877.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20289.77},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19078.42},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25938.12},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22200.24},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23356.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11433.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11433.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20143.02},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32223.29},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36249.13},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25680.62},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38919.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11877.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28208.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11877.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11655.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20223.32},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11100.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11266.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11655.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24234.37},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11766.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21418.05},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29497.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11655.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21418.05},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24600.79},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11877.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22117.94,"maximum":80136.11,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":61069.11},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":42130.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69626.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23666.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":41776.93},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":39282.74},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":53406.97},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":45710.62},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":48090.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22781.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22781.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":41474.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":66348.24},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":74637.49},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":52876.78},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80136.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23666.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":58081.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23666.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23223.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41640.1},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22117.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22449.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23223.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":49898.91},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23445.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":44100.09},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22117.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60735.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23223.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":44100.09},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":50653.39},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22117.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23666.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37682.86,"maximum":138363.75,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":105442.5},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":72742.73},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":120217.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40320.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":72132.44},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":67825.95},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":92212.97},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":78924.38},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":83034.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38813.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":38813.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":71610.74},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":114557.49},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":128869.79},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":91297.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138363.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40320.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100284.56},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40320.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39567.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71896.19},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37682.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38248.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39567.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":86155.93},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39943.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":76143.62},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37682.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":104866.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39567.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":76143.62},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":87458.61},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37682.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40320.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37047.45,"10th_percentile":37047.45,"90th_percentile":37047.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32175.17,"maximum":117759.73,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":89740.85},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":61910.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102315.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34427.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":61391.05},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":57725.85},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":78481.36},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":67171.6},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":70669.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33140.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33140.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":60947.04},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":97498.51},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":109679.54},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":77702.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":117759.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34427.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":85350.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34427.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33783.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61189.99},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32175.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32657.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33783.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":73326.28},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34105.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":64804.92},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32175.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89250.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33783.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":64804.92},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":74434.98},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32175.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34427.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32174.43,"10th_percentile":32174.43,"90th_percentile":32174.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44798.74,"maximum":164983.95,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":125728.89},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":86737.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143346.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47934.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":86010.2},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":80875.18},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":109954.09},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":94108.87},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":99009.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46142.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":46142.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":85388.13},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":136597.53},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":153663.42},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":108862.53},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164983.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47934.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":119578.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47934.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47038.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85728.51},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44798.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45470.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47038.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":102731.72},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47486.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":90793.11},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44798.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125042.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47038.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":90793.11},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":104285.02},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44798.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47934.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29524.53,"10th_percentile":29524.53,"90th_percentile":29524.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41748.43,"maximum":153572.89,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":117032.88},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":80738.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":133431.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44670.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":80061.33},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":75281.47},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":102349.15},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":87599.86},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":92161.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43000.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":43000.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":79482.29},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":127149.81},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":143035.34},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":101333.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":153572.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44670.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":111307.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44670.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43835.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79799.12},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41748.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42374.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43835.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":95626.31},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44253.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":84513.43},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41748.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116393.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43835.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":84513.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":97072.18},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41748.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44670.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":43741.62,"10th_percentile":43741.62,"90th_percentile":43741.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":190961.5,"10th_percentile":190961.5,"90th_percentile":190961.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"1 through 10","median_amount":3315.14,"10th_percentile":3315.14,"90th_percentile":3315.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":58149.76,"maximum":214929.51,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":163790.76},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":112996.06},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186741.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62220.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":112048.05},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":105358.5},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":143240.47},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":122598.43},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":128982.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59894.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":59894.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":111237.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":177949.68},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":200181.92},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":141818.46},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":214929.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62220.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":155778.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62220.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61057.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111681.08},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58149.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59022.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61057.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":133831.67},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61638.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":118278.89},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58149.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":162896.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61057.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":118278.89},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":135855.2},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58149.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62220.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":2301.18,"10th_percentile":2301.18,"90th_percentile":2301.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":153985.01,"10th_percentile":153985.01,"90th_percentile":153985.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"1 through 10","median_amount":133831.67,"10th_percentile":133831.67,"90th_percentile":133831.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47187.98,"10th_percentile":47187.98,"90th_percentile":47187.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46256.64,"maximum":170437.87,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":129885.14},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":89605.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148085.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49494.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":88853.47},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":83548.69},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":113588.87},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":97219.85},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":102282.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47644.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":47644.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":88210.83},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":141113.08},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":158743.12},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":112461.23},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":170437.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49494.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":123531.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49494.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48569.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88562.46},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46256.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46950.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48569.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":106127.75},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49032.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":93794.48},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46256.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129175.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48569.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":93794.48},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":107732.4},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46256.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49494.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":64046.72,"maximum":236989.78,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":180602.18},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":124593.92},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":205908.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68529.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":123548.61},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":116172.45},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":157942.61},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":135181.88},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":142220.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65968.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":65968.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":122655.05},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":196214.35},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":220728.5},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":156374.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236989.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68529.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":171767.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68529.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67249.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":123143.98},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64046.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65007.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67249.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":147568.1},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67889.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":130418.98},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64046.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":179615.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67249.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":130418.98},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":149799.32},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64046.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68529.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24364.91,"maximum":88541.89,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":67474.89},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":46549.61},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76929.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26070.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":46159.07},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":43403.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":59009.03},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":50505.38},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":53135.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25095.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25095.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":45825.23},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":73307.76},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":82466.51},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":58423.23},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88541.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26070.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":64174.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26070.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25583.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46007.9},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24364.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24730.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25583.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":55133.01},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25826.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":48725.91},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24364.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67106.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25583.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":48725.91},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":55966.62},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24364.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26070.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22486.48,"10th_percentile":22486.48,"90th_percentile":22486.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37875.99,"maximum":139086.26,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":105993.1},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":73122.57},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":120845.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40527.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":72509.09},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":68180.12},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":92694.49},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":79336.51},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":83467.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39012.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":39012.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":71984.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":115155.68},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":129542.72},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":91774.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139086.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40527.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100808.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40527.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39769.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72271.62},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37875.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38444.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39769.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":86605.82},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40148.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":76541.23},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37875.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105414.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39769.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":76541.23},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":87915.3},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37875.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40527.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38573.38,"maximum":141695.14,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":107981.24},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":74494.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":123111.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41273.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40772.24,"maximum":149921.01,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":114249.91},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":78818.78},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130258.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43626.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":58398.5,"maximum":215860.05,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":164499.9},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":113485.27},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187550.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62486.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":112533.16},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":105814.65},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":143860.63},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":123129.22},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":129540.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60150.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":60150.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":111719.27},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":178720.11},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":201048.61},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":142432.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":215860.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62486.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":156453.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62486.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61318.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":112164.61},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58398.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59274.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61318.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":134411.1},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61902.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":118790.98},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58398.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":163601.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61318.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":118790.98},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":136443.39},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58398.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62486.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":58238.11,"10th_percentile":58238.11,"90th_percentile":58238.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50109.54,"maximum":184851.41,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":140869.23},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":97182.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":160608.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53617.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":96367.6},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":90614.21},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":123194.82},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":105441.51},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":110931.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51612.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":51612.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":95670.62},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":153046.68},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":172167.66},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":121971.82},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":184851.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53617.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":133978.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53617.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52615.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96051.98},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50109.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50861.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52615.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":115102.73},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53116.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":101726.47},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50109.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":140099.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52615.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":101726.47},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":116843.08},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50109.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53617.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50109.54,"maximum":184851.41,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":140869.23},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":97182.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":160608.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":74213.66,"maximum":275023.86,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":209586.71},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":144589.78},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":238954.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":77924.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":171251.04},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":78666.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":151349.7},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74213.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208442.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77924.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":151349.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":173840.36},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74213.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79408.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":75522.76,"maximum":279921.14,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":213318.77},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":147164.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":243209.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":79298.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":174300.47},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":80054.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":154044.75},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75522.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":212153.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79298.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":154044.75},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":176935.89},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75522.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80809.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":600.0,"10th_percentile":600.0,"90th_percentile":600.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43583.58,"maximum":160438.08,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":122264.63},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":84347.98},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139396.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46634.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":83640.33},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":78646.79},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":106924.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":91515.85},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":96281.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44891.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":44891.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":83035.4},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":132833.8},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":149429.47},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":105863.0},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":160438.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46634.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":116283.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46634.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45762.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83366.4},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43583.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44237.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45762.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":99901.11},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46198.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":88291.45},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43583.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":121596.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45762.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":88291.45},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":101411.61},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43583.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46634.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":82414.7,"maximum":305703.57,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":232966.72},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":160719.2},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":265610.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88183.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":159370.81},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":149855.97},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":203737.14},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":174377.07},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":183456.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":84887.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":84887.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":158218.16},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":253105.55},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":284727.43},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":201714.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":305703.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88183.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":221570.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88183.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86535.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158848.85},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":82414.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83650.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86535.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":190354.6},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":87359.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":168233.2},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82414.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":231694.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86535.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":168233.2},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":193232.76},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82414.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88183.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":85756.59,"maximum":318205.42,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":242493.97},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":167291.86},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":276473.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":90044.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":198139.22},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90901.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":175113.15},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85756.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241169.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90044.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":175113.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":201135.08},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85756.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91759.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21352.93,"maximum":77274.2,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":58888.15},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":40625.79},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67139.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22847.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":40284.95},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":37879.83},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51499.64},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":44078.15},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":46373.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21993.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21993.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":39993.59},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":63978.74},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":71971.96},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":50988.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77274.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":22420.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":48116.87},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22634.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":42525.14},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21352.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58566.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22420.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":42525.14},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":48844.4},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21352.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22847.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":33943.01,"10th_percentile":33943.01,"90th_percentile":33943.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1400.0,"10th_percentile":1400.0,"90th_percentile":1400.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22308.95,"10th_percentile":22308.95,"90th_percentile":22308.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49052.94,"maximum":180898.72,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":137857.01},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":95104.87},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":157173.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52486.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":94306.96},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":88676.6},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":120560.54},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":103186.85},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":108559.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50524.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":50524.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":93624.89},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":149774.08},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":168486.18},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":119363.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":180898.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52486.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":131113.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52486.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51505.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93998.1},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49052.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49788.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51505.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":112641.48},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51996.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":99551.24},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49052.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":137104.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51505.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":99551.24},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":114344.62},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49052.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52486.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7768.95,"maximum":26457.14,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":20162.13},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13909.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22987.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8312.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":13792.76},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12969.3},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17632.45},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15091.48},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15877.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8002.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8002.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13693.01},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21905.04},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24641.76},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17457.41},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26457.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8312.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19175.85},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8312.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8157.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13747.59},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7768.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7885.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8157.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16474.26},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8235.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14559.76},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7768.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20052.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8157.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14559.76},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16723.35},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7768.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8312.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"1 through 10","median_amount":2400.92,"10th_percentile":2400.92,"90th_percentile":2400.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14456.48,"maximum":51474.9,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":39227.34},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27062.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44724.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15468.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26835.14},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25233.01},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34305.62},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29361.92},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30890.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14890.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14890.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26641.05},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42618.36},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47942.9},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33965.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51474.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15468.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":37308.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15468.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15179.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26747.25},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14456.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14673.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15179.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32052.24},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15323.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28327.4},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14456.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39013.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15179.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":28327.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32536.87},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14456.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15468.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":450.0,"10th_percentile":450.0,"90th_percentile":450.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14456.63,"10th_percentile":14456.63,"90th_percentile":14456.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":7334.75,"10th_percentile":7334.75,"90th_percentile":7334.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14802.84,"10th_percentile":14802.84,"90th_percentile":14802.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6764.2,"maximum":22698.44,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":17297.74},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11933.37},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19721.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7237.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11833.25},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11126.78},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15127.45},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12947.47},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13621.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7237.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7102.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11794.5},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6764.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6865.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7102.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14133.8},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7170.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12491.29},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6764.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17203.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7102.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12491.29},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14347.5},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6764.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7237.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6062.28,"10th_percentile":6062.28,"90th_percentile":6062.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7069.62,"10th_percentile":7069.62,"90th_percentile":7069.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5731.65,"maximum":18835.71,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":14354.08},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9902.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16365.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6132.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":9819.52},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9233.27},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":12553.12},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10744.12},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11303.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5903.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5903.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9748.5},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":15594.92},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17543.28},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12428.5},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18835.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6132.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13651.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6132.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6018.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9787.36},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5731.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5817.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6018.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11728.56},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6075.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10365.57},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14275.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6018.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10365.57},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":11905.9},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6132.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1325.53,"10th_percentile":1325.53,"90th_percentile":1325.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7995.15,"maximum":27303.35,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":20806.99},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14354.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23722.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8554.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14233.91},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13384.11},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18196.4},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15574.16},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16385.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8235.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8235.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14130.96},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22605.65},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25429.9},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18015.76},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27303.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8554.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19789.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8554.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8394.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14187.29},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7995.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8115.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8394.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17001.17},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8474.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15025.44},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7995.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20693.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8394.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15025.44},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17258.22},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7995.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8554.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":15945.48,"10th_percentile":15945.48,"90th_percentile":17796.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":16397.63,"10th_percentile":16397.63,"90th_percentile":16397.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7999.68,"10th_percentile":7999.68,"90th_percentile":7999.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":8189.36,"10th_percentile":8189.36,"90th_percentile":8189.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3315.0,"10th_percentile":3315.0,"90th_percentile":3884.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3884.52,"10th_percentile":3884.52,"90th_percentile":3884.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6070.57,"maximum":20103.61,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":15320.3},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10569.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17467.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6495.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":10480.51},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9854.79},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":13398.11},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11467.34},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12064.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6252.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6252.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10404.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16644.67},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18724.18},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13265.11},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20103.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6495.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14570.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6495.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6374.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10446.18},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6070.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6161.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6374.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12518.05},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6434.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11063.31},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6070.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15236.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6374.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11063.31},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12707.33},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6070.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6495.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8957.81,"maximum":30904.62,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":23551.4},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16247.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26851.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9584.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16111.34},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15149.45},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20596.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17628.37},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18546.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9226.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9226.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15994.82},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25587.31},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28784.07},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20392.02},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30904.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9584.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22399.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9584.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9405.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16058.57},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8957.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9092.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9405.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19243.6},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9495.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17007.27},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8957.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23422.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9405.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17007.27},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19534.56},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8957.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9584.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9358.11,"10th_percentile":9358.11,"90th_percentile":9358.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":30904.62,"10th_percentile":30904.62,"90th_percentile":30904.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3451.74,"10th_percentile":3451.74,"90th_percentile":3451.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8723.56,"10th_percentile":8723.56,"90th_percentile":8723.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13953.73,"maximum":49594.14,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":37794.08},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26073.4},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43089.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14930.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25854.65},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24311.06},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33052.18},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28289.11},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29762.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14372.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14372.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25667.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41061.19},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46191.19},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32724.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49594.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14930.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35945.3},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14930.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14651.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25769.97},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13953.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14163.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14651.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30881.14},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14790.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27292.39},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13953.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37587.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14651.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27292.39},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31348.06},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13953.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14930.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14302.07,"10th_percentile":14302.07,"90th_percentile":14302.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6078.84,"maximum":20134.53,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":15343.87},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10585.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17493.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6504.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":10496.63},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9869.95},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":13418.72},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11484.98},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12083.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6261.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6261.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10420.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16670.27},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18752.98},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13285.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20134.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6504.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14593.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6504.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6382.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10462.25},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6078.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6170.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6382.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12537.31},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6443.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11080.33},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6078.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15260.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6382.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11080.33},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12726.87},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6078.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6504.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7829.07,"maximum":26682.05,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":20333.52},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14027.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23182.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8377.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":13910.01},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13079.55},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17782.34},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15219.77},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16012.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8063.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8063.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13809.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22091.25},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24851.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17605.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26682.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8377.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19338.86},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8377.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8220.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13864.45},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7829.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7946.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8220.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16614.3},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8298.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14683.53},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7829.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20222.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8220.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14683.53},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16865.51},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7829.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8377.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8181.98,"10th_percentile":8181.98,"90th_percentile":8181.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14878.82,"maximum":53054.85,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":40431.37},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27892.82},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46096.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15920.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":27658.8},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26007.5},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35358.58},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30263.14},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":31838.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15325.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15325.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27458.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43926.47},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49414.44},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":35007.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53054.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15920.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":38453.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15920.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15622.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27568.22},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14878.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15102.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15622.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33036.04},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15771.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29196.87},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14878.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40210.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15622.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29196.87},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":33535.54},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14878.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15920.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":30263.14,"10th_percentile":30263.14,"90th_percentile":30263.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15250.0,"10th_percentile":15250.0,"90th_percentile":15250.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5419.78,"maximum":17669.02,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":13464.98},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9289.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15351.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5799.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":9211.3},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":8661.36},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":11775.58},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10078.63},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":10603.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5582.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5582.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9144.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":14628.97},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16456.64},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11658.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17669.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5799.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12806.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5799.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5690.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9181.13},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5419.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5501.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5690.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11002.09},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5744.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":9723.52},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5419.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13391.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5690.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":9723.52},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":11168.45},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5419.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5799.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1916.42,"10th_percentile":1916.42,"90th_percentile":1916.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3900.63,"10th_percentile":3900.63,"90th_percentile":3900.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6752.93,"maximum":22656.27,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":17265.6},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11911.2},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19684.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7225.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11811.27},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11106.11},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15099.34},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12923.41},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13596.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6955.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6955.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11725.85},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18758.13},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21101.69},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14949.45},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22656.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7225.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16421.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7225.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7090.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11772.59},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6752.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6854.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7090.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14107.54},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7158.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12468.08},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6752.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17171.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7090.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12468.08},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14320.84},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6752.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7225.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7053.03,"10th_percentile":7053.03,"90th_percentile":7053.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":13450.59,"10th_percentile":13450.59,"90th_percentile":13450.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6759.86,"10th_percentile":6759.86,"90th_percentile":6759.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7057.85,"10th_percentile":7057.85,"90th_percentile":7057.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10574.27,"maximum":36951.73,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":28159.71},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19426.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32105.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11314.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19263.85},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18113.75},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24626.6},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21077.72},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22175.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10891.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10891.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19124.52},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30593.97},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34416.25},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24382.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36951.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11314.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26782.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11314.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11102.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19200.76},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10574.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10732.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11102.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23008.99},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11208.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20335.08},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10574.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28005.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11102.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20335.08},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23356.89},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10574.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11314.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":30576.89,"10th_percentile":30576.89,"90th_percentile":30576.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":21077.72,"10th_percentile":21077.72,"90th_percentile":30593.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10494.14,"10th_percentile":10494.14,"90th_percentile":10494.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11260.08,"10th_percentile":11260.08,"90th_percentile":11260.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10581.98,"10th_percentile":10574.48,"90th_percentile":10588.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3955.84,"10th_percentile":3955.84,"90th_percentile":3955.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":6468.43,"10th_percentile":6468.43,"90th_percentile":6468.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9059.72,"10th_percentile":8668.18,"90th_percentile":11049.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5521.23,"maximum":18048.55,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":13754.21},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9488.76},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15681.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5907.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":9409.15},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":8847.4},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":12028.51},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10295.11},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":10831.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5686.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5686.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9341.1},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":14943.19},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16810.13},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11909.1},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18048.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5907.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13081.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5907.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5797.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9378.34},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5521.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5604.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5797.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11238.42},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5852.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":9932.38},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5521.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13679.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5797.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":9932.38},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":11408.34},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5521.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5907.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7031.73,"maximum":23699.26,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":18060.43},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12459.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20591.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7523.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12355.01},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11617.38},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15794.45},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13518.35},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14222.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7242.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7242.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12265.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19621.67},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22073.11},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15637.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23699.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7523.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17176.97},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7523.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7383.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12314.54},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7031.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7137.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7383.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14756.98},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7453.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13042.05},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7031.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17961.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7383.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13042.05},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14980.11},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7031.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7523.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5571.41,"10th_percentile":5571.41,"90th_percentile":5571.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"1 through 10","median_amount":14756.98,"10th_percentile":14756.98,"90th_percentile":14756.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2613.33,"10th_percentile":2613.33,"90th_percentile":2613.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9020.93,"maximum":31140.77,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":23731.36},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16371.81},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27056.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9652.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16234.45},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15265.21},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20753.87},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17763.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18688.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9291.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9291.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16117.04},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25782.83},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29004.02},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20547.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31140.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9652.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22570.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9652.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9471.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16181.28},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9020.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9156.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9471.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19390.64},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9562.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17137.23},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9020.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23601.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9471.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17137.23},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19683.83},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9020.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9652.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":16309.59,"10th_percentile":16309.59,"90th_percentile":16309.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9025.23,"10th_percentile":9025.23,"90th_percentile":9025.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3542.67,"10th_percentile":3542.67,"90th_percentile":3542.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3542.67,"10th_percentile":3542.67,"90th_percentile":3542.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9426.99,"10th_percentile":9426.99,"90th_percentile":9426.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9980.59,"maximum":34730.8,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":26467.21},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18259.21},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30175.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10679.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18106.02},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17025.05},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23146.45},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19810.87},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20842.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10280.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10280.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17975.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28755.17},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32347.71},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":22916.67},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34730.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10679.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25172.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10679.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10479.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18046.72},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9980.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10130.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10479.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21626.07},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10579.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19112.87},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9980.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26322.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10479.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19112.87},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21953.06},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9980.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10679.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":28739.11,"10th_percentile":28739.11,"90th_percentile":28739.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":28148.6,"10th_percentile":28148.6,"90th_percentile":28148.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9940.79,"10th_percentile":9940.79,"90th_percentile":9940.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":26711.59,"10th_percentile":26711.59,"90th_percentile":26711.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9464.32,"10th_percentile":9461.92,"90th_percentile":9990.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3164.22,"10th_percentile":2374.86,"90th_percentile":4655.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"1 through 10","median_amount":26322.67,"10th_percentile":26322.67,"90th_percentile":26322.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3164.22,"10th_percentile":3164.22,"90th_percentile":7634.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10220.86,"10th_percentile":8569.56,"90th_percentile":10429.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6086.35,"maximum":20162.64,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":15365.29},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10600.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17518.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6512.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":10511.28},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9883.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":13437.46},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11501.02},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12099.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6268.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6268.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10435.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16693.55},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18779.16},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13304.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20162.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6512.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14613.67},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":6451.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11095.8},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6086.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15281.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6390.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11095.8},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12744.64},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6086.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6512.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8129.66,"maximum":27806.57,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":21190.48},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14618.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24159.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8698.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14496.25},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13630.79},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18531.78},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15861.21},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16687.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8373.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8373.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14391.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23022.29},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25898.59},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18347.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27806.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8698.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20153.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8698.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8536.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14448.77},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8129.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8251.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8536.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17314.51},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8617.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15302.37},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8129.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21074.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8536.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15302.37},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17576.31},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8129.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8698.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12408.66,"maximum":43814.11,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":33389.3},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23034.63},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38067.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13277.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22841.38},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21477.69},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29200.06},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24992.11},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26293.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12780.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12780.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22676.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36275.65},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40807.76},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28910.18},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43814.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13277.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31756.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13277.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13029.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22766.57},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12408.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12594.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13029.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27282.04},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13153.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24111.55},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12408.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33206.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13029.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24111.55},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27694.55},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12408.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13277.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7732.65,"10th_percentile":7732.65,"90th_percentile":7732.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6607.14,"maximum":22110.87,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":16849.98},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11624.47},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19211.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7069.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11526.94},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10838.76},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14735.86},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12612.31},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13269.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6805.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6805.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11443.58},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18306.57},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20593.72},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14589.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22110.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7069.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16025.72},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7069.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6937.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11489.19},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6607.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6706.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6937.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13767.93},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7003.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12167.94},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6607.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16757.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6937.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12167.94},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13976.11},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6607.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7069.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8693.28,"maximum":29915.04,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":22797.28},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15727.4},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25991.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9301.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15595.45},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14664.36},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19936.98},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17063.91},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17952.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8954.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8954.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15482.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24767.99},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27862.39},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19739.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29915.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9301.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21682.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9301.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9127.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15544.37},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8693.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8823.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9127.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18627.41},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9214.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16462.69},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8693.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22672.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9127.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16462.69},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18909.06},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8693.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9301.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12193.73,"maximum":43010.08,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":32776.58},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22611.92},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37369.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13047.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22422.21},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21083.55},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28664.21},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24533.48},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25810.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12559.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12559.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22260.05},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35609.95},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40058.9},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28379.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43010.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13047.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31173.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13047.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12803.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22348.78},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12193.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12376.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12803.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26781.39},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12925.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23669.08},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12193.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32597.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12803.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23669.08},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27186.32},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12193.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13047.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12199.37,"10th_percentile":12199.37,"90th_percentile":12199.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12741.29,"10th_percentile":12741.29,"90th_percentile":12741.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6361.4,"maximum":21191.58,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":16149.41},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11141.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18412.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6806.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11047.69},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10388.12},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14123.2},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12087.94},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12717.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6552.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6552.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10967.79},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17545.45},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19737.5},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13982.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21191.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6806.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15359.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6806.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6679.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11011.51},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6361.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6456.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6679.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13195.51},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6743.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11662.04},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6361.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16061.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6679.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11662.04},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13395.03},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6361.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6806.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8745.13,"maximum":30109.02,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":22945.1},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15829.38},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26160.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9357.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15696.58},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14759.45},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20066.26},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17174.56},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18068.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9007.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9007.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15583.05},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24928.6},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28043.06},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19867.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30109.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9357.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21822.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9357.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9182.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15645.17},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8745.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8876.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9182.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18748.2},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9269.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16569.44},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22819.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9182.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16569.44},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19031.67},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9357.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13968.01,"maximum":49647.56,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":37834.78},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26101.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43136.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14945.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25882.5},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24337.25},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33087.78},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28319.58},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29794.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14387.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14387.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25695.3},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41105.42},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46240.94},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32759.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49647.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14945.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35984.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14945.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14666.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25797.73},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13968.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14177.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14666.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30914.4},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14806.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27321.79},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13968.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37628.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14666.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27321.79},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31381.82},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13968.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14945.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":28319.58,"10th_percentile":28319.58,"90th_percentile":28319.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6370.42,"maximum":21225.32,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":16175.12},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11158.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18441.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6816.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11065.28},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10404.66},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14145.68},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12107.18},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12737.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6561.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6561.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10985.25},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17573.38},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19768.92},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14005.25},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21225.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6816.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15383.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6816.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6688.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11029.04},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6370.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6465.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6688.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13216.52},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6752.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11680.61},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6370.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16086.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6688.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11680.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13416.35},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6370.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6816.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8031.22,"maximum":27438.29,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":20909.82},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14425.28},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23839.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8593.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14304.26},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13450.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18286.34},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15651.14},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16466.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8272.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8272.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14200.8},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22717.38},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25555.58},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18104.8},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27438.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":8432.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17085.19},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8513.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15099.7},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8031.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20795.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8432.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15099.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17343.52},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8031.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8593.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":18286.34,"10th_percentile":18286.34,"90th_percentile":18286.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12440.22,"maximum":43932.19,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":33479.28},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23096.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38170.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13311.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22902.93},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21535.57},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29278.75},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25059.46},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26364.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12813.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12813.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22737.29},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36373.41},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40917.74},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28988.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43932.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13311.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31841.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13311.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13062.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22827.92},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12440.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12626.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13062.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27355.56},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13186.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24176.53},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12440.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33296.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13062.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24176.53},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27769.18},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12440.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13311.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":36373.41,"10th_percentile":36373.41,"90th_percentile":36373.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6746.16,"maximum":22630.97,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":17246.32},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11897.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19662.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7218.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11798.08},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11093.71},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15082.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12908.98},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13581.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6948.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11712.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18737.18},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21078.12},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14932.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22630.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7218.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16402.68},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7218.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7083.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11759.44},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6746.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6847.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7083.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14091.78},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7150.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12454.16},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6746.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17152.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7083.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12454.16},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14304.85},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6746.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7218.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":12408.98,"10th_percentile":12408.98,"90th_percentile":12408.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6909.76,"10th_percentile":6909.76,"90th_percentile":6909.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11019.15,"maximum":38616.02,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":29428.01},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20301.81},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33551.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11790.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20131.48},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18929.58},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25735.77},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22027.05},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23174.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11349.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11349.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19985.88},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31971.91},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35966.34},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25480.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38616.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11790.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27988.47},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11790.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11570.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20065.55},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11019.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11184.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11570.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24045.31},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11680.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21250.97},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11019.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29267.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11570.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21250.97},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24408.87},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11019.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11790.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2933.85,"10th_percentile":2933.85,"90th_percentile":2933.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11514.33,"10th_percentile":11514.33,"90th_percentile":11514.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23064.07,"maximum":83675.53,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":63766.39},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":43991.19},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72701.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24678.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":43622.12},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":41017.77},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":55765.83},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":47729.55},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":50214.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23755.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23755.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":43306.62},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":69278.69},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":77934.06},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":55212.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83675.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24678.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":60647.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24678.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24217.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43479.25},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23064.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23410.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24217.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":52102.83},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24447.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":46047.88},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23064.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63418.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24217.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":46047.88},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":52890.63},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23064.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24678.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22329.17,"10th_percentile":22329.17,"90th_percentile":22329.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10965.04,"maximum":38413.6,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":29273.75},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20195.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33375.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11732.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20025.96},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18830.36},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25600.87},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21911.59},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23052.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11293.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11293.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19881.12},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31804.33},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35777.82},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25346.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38413.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11732.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27841.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11732.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11513.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19960.37},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10965.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11129.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11513.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23919.27},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11622.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21139.57},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10965.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29113.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11513.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21139.57},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24280.93},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10965.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11732.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11239.57,"10th_percentile":11239.57,"90th_percentile":11239.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14249.07,"maximum":50698.98,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":38636.04},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26654.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44049.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15246.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26430.63},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24852.66},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33788.5},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28919.32},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30425.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14676.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14676.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26239.47},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41975.94},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47220.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33453.07},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50698.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15246.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":36746.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15246.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14961.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26344.07},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14249.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14462.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14961.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31569.09},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15104.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27900.4},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14249.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38425.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14961.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27900.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32046.42},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14249.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15246.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28785.19,"maximum":105077.96,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":80076.48},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":55243.21},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91297.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30800.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":54779.73},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":51509.24},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":70029.55},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":59937.76},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":63058.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29648.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29648.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":54383.54},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":86998.71},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":97867.94},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":69334.34},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105077.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30800.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":76159.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30800.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30224.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54600.32},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28785.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29216.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30224.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":65429.63},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30512.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":57825.96},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28785.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79639.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30224.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":57825.96},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":66418.93},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28785.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30800.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1064.76,"10th_percentile":1064.76,"90th_percentile":1064.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15081.72,"maximum":53813.9,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":41009.82},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28291.88},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46756.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16137.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28054.52},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26379.59},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35864.45},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30696.11},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32294.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15534.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15534.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27851.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44554.92},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50121.41},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":35508.41},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53813.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16137.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":39003.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16137.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15835.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27962.63},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15081.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15307.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15835.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33508.68},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15986.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29614.59},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15081.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40785.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15835.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29614.59},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34015.33},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15081.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16137.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19664.32,"maximum":70957.21,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":54074.18},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":37304.72},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61651.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21040.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":36991.74},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":34783.24},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47289.66},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":40474.86},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":42582.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20254.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20254.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":36724.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":58748.62},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":66088.42},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":46820.2},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70957.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":20647.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":44183.43},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20844.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39048.8},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19664.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53778.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20647.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":39048.8},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":44851.48},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19664.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21040.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20534.15,"10th_percentile":20534.15,"90th_percentile":20534.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34377.04,"maximum":125996.84,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":96018.08},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":66241.0},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":109472.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36783.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":65685.26},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":61763.69},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":83971.0},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":71870.14},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":75612.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35408.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":35408.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":65210.19},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":104318.38},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":117351.45},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":83137.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125996.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36783.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":91321.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36783.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36095.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65470.13},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34377.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34892.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36095.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":78455.34},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36439.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":69337.93},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34377.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95493.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36095.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":69337.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":79641.59},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34377.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36783.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":61610.4,"10th_percentile":61610.4,"90th_percentile":61610.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"1 through 10","median_amount":79009.29,"10th_percentile":79009.29,"90th_percentile":79009.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6020.97,"maximum":19918.06,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":15178.9},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10471.63},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17305.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6442.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":10383.78},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9763.84},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":13274.46},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11361.51},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11953.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6201.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6201.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10308.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16491.05},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18551.36},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13142.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19918.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6442.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14436.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6442.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6322.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10349.77},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6020.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6111.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6322.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12402.52},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6382.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10961.2},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6020.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15096.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6322.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10961.2},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12590.05},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6020.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6442.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7533.73,"maximum":25577.21,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":19491.56},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13446.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22222.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8061.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":13334.03},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12537.95},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17046.01},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14589.55},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15349.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7759.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7759.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13237.59},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21176.5},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23822.2},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16876.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25577.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8061.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18538.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8061.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7910.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13290.36},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7533.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7646.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7910.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15926.34},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7985.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14075.52},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7533.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19385.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7910.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14075.52},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16167.15},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7533.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8061.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13598.27,"maximum":48264.4,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":36780.72},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25374.3},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41934.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14550.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25161.42},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23659.22},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32165.96},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27530.6},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28964.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14006.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14006.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24979.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39960.24},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44952.69},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31846.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48264.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14550.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":34981.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14550.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14278.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25079.01},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13598.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13802.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14278.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30053.13},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14414.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26560.61},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13598.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36579.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14278.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26560.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30507.54},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13598.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14550.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Hmo","methodology":"fee schedule","standard_charge_dollar":6184.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12097.93},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6243.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10692.01},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5890.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14725.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6184.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10692.01},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12280.85},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5890.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6302.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7584.08,"maximum":25765.56,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":19635.1},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13545.87},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22386.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8114.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":13432.22},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12630.29},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17171.54},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14696.99},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15462.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7811.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7811.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13335.08},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21332.45},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23997.64},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17001.08},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25765.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":7963.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16043.63},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8039.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14179.17},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7584.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19527.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7963.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14179.17},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16286.21},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7584.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8114.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13317.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6244.17,"maximum":20753.02,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":15815.2},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10910.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18031.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1525.14,"10th_percentile":1525.14,"90th_percentile":1525.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9580.79,"maximum":33235.19,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":25327.45},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17472.92},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28876.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10251.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17326.32},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16291.9},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22149.7},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18957.76},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19944.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9868.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9868.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17201.01},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27516.89},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30954.72},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21929.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33235.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10251.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":24088.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10251.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10059.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17269.58},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9580.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9724.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10059.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20694.79},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10155.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18289.82},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9580.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25189.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10059.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18289.82},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21007.69},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9580.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10251.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6212.61,"maximum":20634.94,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":15725.22},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10848.52},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17928.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6647.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":10757.5},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10115.25},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":13752.22},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11770.42},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12383.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6398.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6398.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10679.7},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17084.58},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19219.06},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13615.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20634.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6647.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14955.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6647.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6523.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10722.27},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6212.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6305.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6523.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12848.9},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6585.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11355.71},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6212.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15639.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6523.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11355.71},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13043.18},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6212.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6647.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10702.77,"maximum":37432.46,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":28526.06},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19679.57},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32523.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11451.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19514.46},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18349.4},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24946.98},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21351.93},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22463.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11023.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11023.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19373.33},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30991.99},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34864.0},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24699.33},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37432.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11451.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27130.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11451.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11237.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19450.55},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10702.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10863.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11237.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23308.33},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11344.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20599.64},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10702.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28370.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11237.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20599.64},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23660.76},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10702.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11451.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6344.87,"maximum":21129.73,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":16102.28},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11108.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18358.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6789.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11015.45},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10357.8},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14081.98},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12052.66},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12680.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6535.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6535.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10935.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17494.24},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19679.89},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13942.18},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21129.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6789.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15314.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6789.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6662.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10979.37},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6344.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6440.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6662.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13157.0},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6725.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11628.0},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6344.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16014.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6662.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11628.0},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13355.93},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6344.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6789.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5905.1,"10th_percentile":5905.1,"90th_percentile":5905.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6631.59,"10th_percentile":6631.59,"90th_percentile":6631.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6686.8,"maximum":22408.87,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":17077.07},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11781.14},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19469.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7154.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11682.3},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10984.84},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14934.47},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12782.3},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13447.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6887.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6887.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11597.81},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18553.3},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20871.27},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14786.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22408.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7154.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16241.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7154.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7021.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11644.04},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6686.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6787.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7021.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13953.49},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7088.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12331.93},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6686.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16983.81},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7021.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12331.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14164.47},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6686.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7154.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10251.88,"maximum":35745.68,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":27240.62},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18792.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31057.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10969.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18635.1},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17522.54},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23822.82},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20389.77},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21451.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10559.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10559.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18500.33},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29595.43},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33292.96},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":23586.33},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35745.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10969.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25908.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10969.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10764.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18574.07},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10251.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10405.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10764.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22258.01},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10866.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19671.38},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10251.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27091.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10764.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19671.38},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22594.56},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10251.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10969.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16608.75,"maximum":59526.47,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":45363.18},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31295.17},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51719.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17771.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":31032.61},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":29179.89},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39671.61},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33954.63},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35722.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17107.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17107.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30808.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49284.6},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55442.0},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":39277.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59526.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17771.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":43144.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17771.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17439.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30930.98},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16608.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16857.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17439.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37065.76},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17605.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32758.3},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16608.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45115.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17439.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32758.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":37626.2},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16608.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17771.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9731.84,"maximum":33800.26,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":25758.08},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17769.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29367.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10413.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17620.91},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16568.9},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22526.29},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19280.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20284.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":10315.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18600.78},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9731.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25617.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10218.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18600.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21364.87},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9731.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10413.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14679.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30871.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12693.48,"maximum":44879.59,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":34201.27},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23594.79},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38993.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13582.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23396.84},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21999.99},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29910.15},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25599.87},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26932.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13074.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13074.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23227.62},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37157.81},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41800.14},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29613.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44879.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":13328.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27945.49},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13455.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24697.9},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12693.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34014.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13328.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24697.9},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28368.03},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12693.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13582.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17087.45,"maximum":61317.26,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":46727.89},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32236.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53275.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18283.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":31966.2},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30057.74},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40865.09},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":34976.12},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":36797.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17600.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17600.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":31735.01},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50767.28},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":57109.92},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":40459.41},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61317.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":17941.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38180.85},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18112.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33743.8},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17087.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46472.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17941.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33743.8},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":38758.15},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17087.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18283.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32750.06,"maximum":119910.38,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":91379.79},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":63041.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":104184.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35042.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":62512.24},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":58780.1},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":79914.66},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":68398.35},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":71959.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33732.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33732.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":62060.12},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":99279.12},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":111682.62},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":79121.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":119910.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35042.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":86909.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35042.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34387.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62307.5},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32750.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33241.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34387.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":74665.44},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34715.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":65988.46},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32750.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90880.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34387.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":65988.46},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":75794.38},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32750.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35042.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9982.84,"maximum":34739.23,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":26473.64},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18263.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30183.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10681.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18110.42},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17029.18},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23152.08},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19815.69},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20847.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10282.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10282.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17979.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28762.15},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32355.57},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":22922.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34739.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10681.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25178.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10681.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10481.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18051.11},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9982.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10132.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10481.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21631.32},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10581.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19117.51},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26329.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10481.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19117.51},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21958.39},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10681.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7356.38,"maximum":24913.74,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":18985.95},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13098.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21646.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7871.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12988.15},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12212.72},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16603.84},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14211.1},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14951.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7577.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12894.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20627.19},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23204.26},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16439.01},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24913.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7871.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18057.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7871.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7724.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12945.61},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7356.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7466.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7724.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15513.21},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7797.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13710.4},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7356.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18882.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7724.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13710.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15747.77},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7356.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7871.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11917.94,"maximum":41978.33,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":31990.32},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22069.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36472.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12752.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21884.34},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20577.79},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27976.6},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23944.96},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25191.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12275.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12275.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21726.06},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34755.72},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39097.95},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27698.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41978.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12752.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30425.44},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12752.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12513.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21812.67},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11917.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12096.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12513.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26138.94},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12633.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23101.3},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11917.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31815.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12513.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23101.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26534.16},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11917.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12752.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8326.55,"maximum":28543.13,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":21751.79},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15006.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24799.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":8742.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17773.15},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8826.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15707.71},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8326.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21633.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8742.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15707.71},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18041.88},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8326.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8909.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17004.04,"maximum":61005.21,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":46490.08},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32072.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53004.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18194.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6466.61,"maximum":21585.16,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":16449.35},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11348.08},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18754.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6919.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11252.88},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10581.05},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14385.5},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12312.44},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12953.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6660.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6660.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11171.49},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17871.31},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20104.08},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14242.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21585.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6919.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15644.69},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6919.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6789.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11216.02},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6466.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6563.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6789.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13440.58},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6854.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11878.63},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6466.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16359.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6789.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11878.63},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13643.81},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6466.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6919.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":9135.5,"10th_percentile":9135.5,"90th_percentile":9135.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10639.65,"maximum":37196.31,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":28346.09},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19555.42},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32318.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11384.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19391.35},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18233.64},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24789.6},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21217.23},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22322.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10958.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10958.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19251.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30796.48},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34644.05},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24543.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37196.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11384.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26959.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11384.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11171.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19327.84},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10639.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10799.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11171.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23161.29},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11278.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20469.68},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10639.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28191.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11171.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20469.68},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23511.49},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10639.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11384.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6698.07,"maximum":22451.04,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":17109.21},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11803.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19506.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":7032.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13979.75},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7099.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12355.14},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6698.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17015.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7032.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12355.14},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14191.12},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6698.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7166.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6601.88,"maximum":22091.2,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":16834.98},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11614.12},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19193.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":6931.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13755.68},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6997.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12157.11},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16743.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6931.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12157.11},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13963.67},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7064.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9438.76,"maximum":32703.85,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":24922.54},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17193.57},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28414.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":9910.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20363.94},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10005.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17997.41},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9438.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24786.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9910.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17997.41},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20671.84},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9438.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10099.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8849.59,"maximum":30499.79,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":23242.9},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16034.82},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26499.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":9292.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18991.52},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9380.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16784.49},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8849.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23115.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9292.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16784.49},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19278.67},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8849.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9469.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14284.39,"maximum":50831.12,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":38736.73},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26723.72},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44164.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":14998.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31651.37},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15141.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27973.12},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14284.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38525.19},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14998.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27973.12},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32129.94},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14284.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15284.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12231.31,"maximum":43150.64,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":32883.7},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22685.82},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37491.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13087.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22495.49},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21152.46},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28757.89},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24613.66},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25895.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12598.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12598.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22332.8},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35726.33},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40189.82},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28472.4},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43150.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":12842.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26868.92},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12965.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23746.44},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12231.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32704.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12842.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23746.44},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27275.17},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12231.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13087.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10864.34,"maximum":38036.89,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":28986.67},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19997.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33048.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":11407.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23684.7},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11516.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20932.26},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10864.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28828.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11407.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20932.26},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24042.81},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10864.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11624.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18364.99,"maximum":66096.47,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":50369.97},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":34749.26},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57427.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":19283.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":41156.76},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19466.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36373.87},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18364.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50094.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19283.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":36373.87},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":41779.05},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18364.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19650.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6981.38,"maximum":23510.9,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":17916.89},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12360.51},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20427.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7470.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12256.81},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11525.05},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15668.92},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13410.91},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14109.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7190.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7190.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12168.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19465.72},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21897.68},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15513.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23510.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7470.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17040.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7470.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7330.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12216.67},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6981.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7086.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7330.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14639.7},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7400.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12938.4},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6981.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17819.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7330.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12938.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14861.05},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6981.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7470.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":12360.51,"10th_percentile":12360.51,"90th_percentile":12360.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":10410.91,"10th_percentile":10410.91,"90th_percentile":16598.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"1 through 10","median_amount":14639.7,"10th_percentile":14639.7,"90th_percentile":14639.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5317.95,"10th_percentile":5317.95,"90th_percentile":5317.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9120.13,"maximum":31511.86,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":24014.16},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16566.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27379.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9758.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16427.91},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15447.12},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21001.18},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17974.75},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18910.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9393.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9393.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16309.1},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26090.07},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29349.65},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20792.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31511.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9758.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22839.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9758.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9576.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16374.11},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9120.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9256.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9576.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19621.71},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9667.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17341.44},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9120.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23883.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9576.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17341.44},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19918.39},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9120.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9758.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7479.62,"maximum":25374.79,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":19337.3},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13340.43},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22046.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8003.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":13228.51},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12438.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16911.11},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14474.09},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15227.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7704.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7704.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13132.83},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21008.92},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23633.68},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16743.23},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25374.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8003.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18391.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8003.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7853.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13185.18},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7479.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7591.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7853.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15800.3},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7928.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13964.12},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7479.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19231.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7853.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13964.12},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16039.2},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7479.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8003.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7482.02,"10th_percentile":7482.02,"90th_percentile":7482.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":11422.83,"10th_percentile":11422.83,"90th_percentile":11422.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15251.56,"maximum":54449.26,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":41494.0},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28625.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47308.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16319.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28385.74},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26691.04},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36287.88},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31058.52},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32675.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15709.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15709.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28180.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45080.96},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50713.17},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":35927.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54449.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16319.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":39464.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16319.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16014.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28292.77},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15251.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15480.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16014.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33904.3},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16166.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29964.23},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15251.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41267.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16014.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29964.23},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34416.94},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15251.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16319.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":28625.9,"10th_percentile":28625.9,"90th_percentile":28625.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15631.95,"10th_percentile":15631.95,"90th_percentile":15631.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4907.45,"10th_percentile":4907.45,"90th_percentile":4907.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14068.37,"10th_percentile":14068.37,"90th_percentile":14068.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10934.98,"maximum":38301.15,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":29188.06},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20136.27},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33277.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11700.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19967.33},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18775.23},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25525.93},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21847.45},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22985.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11263.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11263.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19822.92},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31711.22},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35673.08},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25272.52},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38301.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11700.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27760.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11700.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11481.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19901.94},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10934.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11099.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11481.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23849.25},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11591.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21077.69},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10934.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29028.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11481.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21077.69},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24209.85},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10934.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11700.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17942.65,"maximum":64516.52,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":49165.94},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33918.62},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56055.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19198.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":33634.05},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31626.02},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42997.25},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":36801.02},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":38717.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18480.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18480.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33390.8},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":53416.09},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60089.66},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":42570.4},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64516.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19198.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":46760.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19198.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18839.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33523.9},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17942.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18211.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18839.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40172.96},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19019.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35504.4},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17942.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48897.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18839.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":35504.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":40780.37},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17942.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19198.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27839.06,"maximum":101538.53,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":77379.2},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":53382.4},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88221.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29787.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":52934.54},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":49774.22},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":67670.68},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":57918.82},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":60934.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28674.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":28674.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":52551.69},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":84068.26},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":94571.37},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":66998.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101538.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29787.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":73594.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29787.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29231.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52761.17},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27839.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28256.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29231.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":63225.71},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29509.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":55878.16},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27839.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76956.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29231.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":55878.16},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":64181.69},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27839.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29787.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20079.15,"maximum":72509.05,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":55256.78},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":38120.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62999.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21484.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37800.76},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":35543.96},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":48323.89},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":41360.05},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":43513.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20681.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20681.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":37527.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":60033.46},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":67533.77},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":47844.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72509.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21484.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":52553.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21484.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21083.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37676.95},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20079.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20380.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21083.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":45149.72},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21283.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39902.8},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20079.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54955.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21083.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":39902.8},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":45832.38},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20079.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21484.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20079.15,"maximum":72509.05,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":55256.78},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":38120.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62999.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21484.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37800.76},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":35543.96},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":48323.89},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":41360.05},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":43513.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20681.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20681.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":37527.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":60033.46},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":67533.77},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":47844.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72509.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":21083.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":45149.72},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21283.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39902.8},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20079.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54955.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21083.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":39902.8},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":45832.38},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20079.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21484.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":57897.35,"10th_percentile":57897.35,"90th_percentile":57897.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27144.68,"maximum":98940.89,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":75399.63},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":52016.73},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85964.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29044.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":51580.33},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":48500.85},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":65939.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":56437.1},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":59375.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27959.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":27959.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":51207.27},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":81917.55},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":92151.97},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":65284.87},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98940.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29044.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":71711.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29044.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28501.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51411.4},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27144.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27551.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28501.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":61608.22},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28773.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":54448.64},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27144.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74987.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28501.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":54448.64},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":62539.74},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27144.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29044.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6680.79,"maximum":22386.38,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":17059.93},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11769.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19450.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7148.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11670.57},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10973.81},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14919.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12769.47},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13434.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6881.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6881.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11586.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18534.68},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20850.32},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14771.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22386.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7148.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16225.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7148.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7014.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11632.35},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6680.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6781.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7014.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13939.49},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7081.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12319.56},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16966.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7014.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12319.56},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14150.25},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7148.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8384.42,"maximum":28759.6,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":21916.75},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15119.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24987.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8971.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14993.09},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14097.96},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19166.93},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16404.83},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17259.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8635.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8635.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14884.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23811.35},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26786.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18976.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28759.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8971.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20844.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8971.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8803.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14943.98},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8384.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8510.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8803.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17907.94},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8887.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15826.83},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8384.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21797.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8803.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15826.83},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18178.71},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8384.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8971.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":15559.03,"10th_percentile":15559.03,"90th_percentile":15559.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":590.0,"10th_percentile":590.0,"90th_percentile":590.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13894.36,"maximum":49372.05,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":37624.83},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25956.64},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42896.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14866.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25738.87},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24202.19},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32904.16},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28162.42},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29628.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14311.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14311.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25552.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40877.31},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45984.34},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32577.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49372.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14866.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35784.33},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14866.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14589.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25654.57},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13894.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14102.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14589.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30742.84},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14728.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27170.17},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13894.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37419.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14589.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27170.17},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31207.67},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13894.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14866.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26521.49,"10th_percentile":26521.49,"90th_percentile":26521.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6882.94,"maximum":23142.62,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":17636.24},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12166.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20107.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7364.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12064.82},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11344.52},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15423.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13200.84},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13888.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7089.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7089.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11977.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19160.8},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21554.67},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15270.36},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23142.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7364.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16773.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7364.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7227.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12025.31},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6882.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6986.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7227.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14410.38},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7295.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12735.73},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6882.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17539.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7227.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12735.73},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14628.26},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6882.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7364.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8952.55,"maximum":30884.94,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":23536.41},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16237.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26834.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9579.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16101.08},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15139.81},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20583.37},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17617.15},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18534.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9221.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9221.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15984.63},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25571.01},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28765.74},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20379.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30884.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9579.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22385.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9579.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9400.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16048.35},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8952.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9086.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9400.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19231.34},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9489.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16996.44},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8952.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23407.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9400.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16996.44},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19522.12},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8952.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9579.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10855.33,"maximum":38003.15,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":28960.96},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19979.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33019.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11615.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7570.55,"maximum":25714.96,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":19596.53},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13519.27},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22342.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8100.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2797.08,"10th_percentile":2797.08,"90th_percentile":2797.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10486.34,"maximum":36622.81,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":27909.04},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19253.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31819.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11220.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19092.37},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17952.51},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24407.39},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20890.1},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21977.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10800.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10800.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18954.29},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30321.65},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34109.9},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24165.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36622.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11220.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26543.82},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11220.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11010.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19029.84},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10486.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10643.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11010.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22804.18},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11115.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20154.07},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10486.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27756.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11010.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20154.07},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23148.98},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10486.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11220.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10494.06,"10th_percentile":10494.06,"90th_percentile":10494.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7784.55,"10th_percentile":7784.55,"90th_percentile":7784.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17769.81,"maximum":63869.92,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":48673.19},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33578.68},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55493.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19013.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":33296.97},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31309.05},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42566.32},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":36432.19},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":38329.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18302.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18302.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33056.15},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":52880.74},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":59487.43},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":42143.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63869.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19013.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":46292.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19013.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18658.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33187.92},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17769.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18036.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18658.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39770.34},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18836.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35148.56},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17769.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48407.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18658.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":35148.56},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":40371.66},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17769.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19013.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18541.29,"10th_percentile":18541.29,"90th_percentile":18541.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18566.04,"10th_percentile":18566.04,"90th_percentile":18566.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7879.42,"maximum":26870.41,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":20477.06},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14126.72},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23346.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8430.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14008.2},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13171.88},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17907.87},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15327.21},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16125.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8115.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8115.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13906.89},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22247.2},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25026.67},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17730.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26870.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8430.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19475.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8430.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8273.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13962.33},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7879.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7997.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8273.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16731.58},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8352.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14787.18},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7879.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20365.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8273.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14787.18},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16984.57},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7879.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8430.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11185.98,"maximum":39240.13,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":29903.62},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20629.92},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34093.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11969.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20456.84},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19235.52},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26151.71},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22383.05},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23548.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11521.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11521.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20308.89},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32488.64},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36547.63},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25892.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39240.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11969.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28440.82},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11969.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11745.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20389.85},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11185.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11353.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11745.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24433.93},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11857.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21594.42},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11185.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29740.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11745.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21594.42},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24803.37},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11185.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11969.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17872.76,"maximum":64255.07,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":48966.69},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33781.17},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55828.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19123.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":33497.75},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31497.85},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42823.0},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":36651.88},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":38560.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18408.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18408.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33255.48},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":53199.63},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":59846.15},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":42397.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64255.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":18766.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40010.16},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18945.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35360.52},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17872.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48699.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18766.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":35360.52},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":40615.11},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17872.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19123.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7427.02,"maximum":25178.0,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":19187.33},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13236.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21875.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7946.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":13125.91},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12342.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16779.96},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14361.84},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15109.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7649.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7649.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13030.98},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20845.99},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23450.39},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16613.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25178.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7946.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18248.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7946.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7798.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13082.92},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7427.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7538.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7798.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15677.76},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7872.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13855.83},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7427.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19082.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7798.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13855.83},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15914.81},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7427.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7946.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14298.66,"maximum":50884.53,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":38777.44},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26751.8},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44211.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15299.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26527.36},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24943.61},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33912.16},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29025.16},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30536.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14727.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14727.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26335.5},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42129.56},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47393.04},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33575.5},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50884.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15299.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":36880.56},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15299.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15013.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26440.48},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14298.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14513.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15013.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31684.63},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15156.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28002.51},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14298.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38565.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15013.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":28002.51},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32163.7},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14298.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15299.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13583.98,"10th_percentile":13583.98,"90th_percentile":13583.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4732.75,"10th_percentile":4732.75,"90th_percentile":4732.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6897.97,"maximum":23198.85,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":17679.08},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12196.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20156.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7380.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12094.13},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11372.08},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15460.95},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13232.91},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13921.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7104.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7104.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12006.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19207.36},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21607.04},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15307.46},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23198.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7380.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16814.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7380.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7242.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12054.52},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6897.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7001.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7242.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14445.39},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7311.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12766.67},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6897.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17582.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7242.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12766.67},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14663.8},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6897.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7380.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15106.52,"maximum":53906.68,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":41080.52},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28340.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46836.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16163.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28102.88},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26425.07},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35926.28},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30749.03},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32350.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15559.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15559.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27899.63},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44631.73},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50207.82},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":35569.63},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53906.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16163.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":39070.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16163.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15861.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28010.84},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15106.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15333.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15861.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33566.45},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16012.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29665.64},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15106.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40856.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15861.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29665.64},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34073.98},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15106.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16163.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8443.03,"maximum":28978.88,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":22083.86},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15235.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25178.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9034.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15107.4},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14205.45},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19313.07},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16529.91},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17390.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8696.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8696.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14998.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23992.9},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26990.47},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19121.34},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28978.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9034.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21003.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9034.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8865.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15057.93},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8443.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8569.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8865.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18044.48},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8949.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15947.51},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8443.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21963.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8865.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15947.51},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18317.32},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8443.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9034.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":37321.48,"10th_percentile":37321.48,"90th_percentile":37321.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8833.56,"10th_percentile":8833.56,"90th_percentile":8833.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":11822.07,"10th_percentile":11822.07,"90th_percentile":11822.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3467.96,"10th_percentile":3467.96,"90th_percentile":3467.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6793.7,"10th_percentile":6793.7,"90th_percentile":6793.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12752.84,"maximum":45101.69,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":34370.52},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23711.55},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39186.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13645.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23512.62},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22108.86},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30058.16},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25726.55},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27066.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13135.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13135.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23342.57},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37341.69},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42006.99},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29759.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45101.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13645.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":32689.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13645.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13390.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23435.61},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12752.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12944.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13390.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28083.78},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13518.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24820.13},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12752.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34182.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13390.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24820.13},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28508.41},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12752.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13645.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13071.52,"10th_percentile":13071.52,"90th_percentile":13071.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6379.44,"maximum":21259.05,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":16200.83},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11176.64},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18470.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6826.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11082.87},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10421.19},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14168.16},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12126.42},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12757.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6570.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6570.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11002.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17601.31},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19800.34},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14027.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21259.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6826.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15408.33},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6826.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6698.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11046.57},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6379.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6475.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6698.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13237.52},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6762.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11699.17},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6379.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16112.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6698.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11699.17},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13437.67},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6379.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6826.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8406.96,"maximum":28843.94,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":21981.02},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15164.28},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25061.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8995.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15037.06},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14139.31},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19223.14},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16452.94},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17309.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8659.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8659.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14928.3},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23881.18},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26864.78},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19032.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28843.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8995.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20905.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8995.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8827.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14987.81},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8406.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8533.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8827.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17960.46},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8911.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15873.25},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8406.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21860.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8827.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15873.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18232.02},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8406.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8995.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8407.87,"10th_percentile":8407.87,"90th_percentile":8407.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13207.5,"maximum":46802.52,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":35666.68},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24605.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40664.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14132.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24399.31},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22942.61},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31191.69},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26696.73},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28086.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13603.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13603.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24222.84},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38749.88},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43591.12},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30882.04},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46802.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14132.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33921.96},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14132.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13867.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24319.4},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13207.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13405.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13867.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29142.86},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13999.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25756.12},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13207.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35471.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13867.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25756.12},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29583.5},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13207.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14132.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6699.57,"maximum":22456.66,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":17113.49},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11806.26},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19511.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7168.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11707.21},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11008.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14966.32},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12809.56},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13476.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6900.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6900.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11622.54},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18592.87},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20915.78},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14817.74},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22456.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7168.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16276.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7168.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7034.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11668.87},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6699.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6800.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7034.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13983.25},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7101.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12358.23},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6699.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17020.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7034.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12358.23},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14194.68},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6699.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7168.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":11806.26,"10th_percentile":11806.26,"90th_percentile":11806.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":10007.68,"10th_percentile":10007.68,"90th_percentile":12555.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7192.55,"maximum":24300.88,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":18518.91},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12775.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21113.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7696.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12668.65},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11912.3},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16195.4},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13861.52},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14583.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7408.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7408.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12577.02},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20119.77},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22633.45},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16034.62},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24300.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7696.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17613.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7696.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7552.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12627.16},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7192.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7300.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7552.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15131.6},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7624.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13373.13},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7192.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18417.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7552.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13373.13},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15360.39},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7192.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7696.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":12577.02,"10th_percentile":12577.02,"90th_percentile":12577.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7196.85,"10th_percentile":7196.85,"90th_percentile":7196.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11733.82,"maximum":41289.56,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":31465.43},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21707.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35874.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12555.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21525.27},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20240.15},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27517.56},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23552.07},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24778.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12085.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12085.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21369.59},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34185.46},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38456.44},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27244.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41289.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12555.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29926.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12555.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12320.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21454.77},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11733.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11909.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12320.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25710.06},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12437.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22722.26},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11733.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31293.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12320.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22722.26},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26098.8},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11733.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12555.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5839.86,"maximum":19240.54,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":14662.59},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10115.43},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16717.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6248.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":10030.57},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9431.72},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":12822.92},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10975.04},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11546.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6015.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6015.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9958.02},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":15930.09},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17920.33},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12695.62},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19240.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6248.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13945.33},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6248.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6131.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9997.72},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5839.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5927.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6131.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11980.64},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6190.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10588.35},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5839.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14582.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6131.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10588.35},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12161.79},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5839.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6248.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8288.98,"maximum":28402.56,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":21644.67},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14932.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24677.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8869.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14806.96},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13922.94},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18928.98},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16201.17},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17044.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8537.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8537.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14699.87},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23515.74},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26453.7},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18741.07},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28402.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8869.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20585.87},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8869.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8703.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14758.46},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8288.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8413.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8703.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17685.62},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8786.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15630.35},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8288.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21526.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8703.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15630.35},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17953.03},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8288.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8869.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8650.85,"10th_percentile":8650.85,"90th_percentile":8650.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8497.41,"10th_percentile":8497.41,"90th_percentile":8497.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"1 through 10","median_amount":15630.35,"10th_percentile":15630.35,"90th_percentile":15630.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15809.16,"maximum":56535.24,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":43083.66},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29722.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49120.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16915.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":29473.22},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27713.59},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37678.1},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":32248.4},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33927.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16283.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16283.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29260.05},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46808.04},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":52656.02},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":37304.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56535.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16915.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":40976.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16915.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16599.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29376.69},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15809.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16046.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16599.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35203.2},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16757.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31112.18},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15809.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42848.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16599.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31112.18},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35735.47},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15809.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16915.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16495.95,"10th_percentile":16495.95,"90th_percentile":16495.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":31898.81,"10th_percentile":29898.4,"90th_percentile":34022.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15807.7,"10th_percentile":15807.7,"90th_percentile":15807.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"1 through 10","median_amount":35203.2,"10th_percentile":35203.2,"90th_percentile":35203.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16187.61,"10th_percentile":16187.61,"90th_percentile":16187.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11246.1,"maximum":39465.03,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":30075.01},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20748.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34289.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12033.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20574.09},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19345.77},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26301.6},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22511.34},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23683.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11583.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11583.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20425.29},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32674.85},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36757.1},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26040.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39465.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12033.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28603.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12033.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11808.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20506.71},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11246.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11414.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11808.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24573.97},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11920.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21718.19},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11246.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29910.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11808.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21718.19},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24945.53},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11246.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12033.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13901.88,"maximum":49400.16,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":37646.25},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25971.42},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42921.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14875.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25753.52},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24215.97},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32922.9},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28178.46},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29645.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14318.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14318.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25567.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40900.59},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46010.52},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32596.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49400.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14875.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35804.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14875.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14596.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25669.18},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13901.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14110.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14596.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30760.35},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14735.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27185.64},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13901.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37440.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14596.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27185.64},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31225.44},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13901.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14875.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":28178.46,"10th_percentile":28178.46,"90th_percentile":28178.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21416.05,"maximum":77510.35,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":59068.11},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":40749.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67344.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22915.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":40408.06},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":37995.6},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51657.03},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":44212.86},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":46515.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22058.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22058.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":40115.81},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":64174.26},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":72191.91},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":51144.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77510.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22915.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":56178.67},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22915.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22486.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40275.72},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21416.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21737.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22486.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":48263.92},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22701.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":42655.09},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21416.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58745.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22486.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":42655.09},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":48993.67},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21416.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22915.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20208.7,"10th_percentile":20208.7,"90th_percentile":20208.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20690.47,"10th_percentile":20690.47,"90th_percentile":20690.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7608.88,"maximum":25858.34,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":19705.8},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13594.64},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22467.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8141.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":13480.59},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12675.76},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17233.37},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14749.91},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15517.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7837.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7837.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13383.09},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21409.26},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24084.04},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17062.29},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25858.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8141.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18741.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8141.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7989.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13436.44},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7608.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7723.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7989.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16101.39},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8065.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14230.23},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7608.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19598.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7989.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14230.23},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16344.85},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7608.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8141.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10021.92,"maximum":34885.42,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":26585.04},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18340.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30310.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10723.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18186.63},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17100.84},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23249.5},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19899.07},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20935.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10322.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10322.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18055.1},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28883.19},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32491.73},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":23018.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34885.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10723.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25284.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10723.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10523.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18127.07},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10021.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10172.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10523.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21722.35},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10623.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19197.96},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10021.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26439.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10523.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19197.96},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22050.79},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10021.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10723.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"1 through 10","median_amount":28867.06,"10th_percentile":28867.06,"90th_percentile":28867.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13543.41,"maximum":48059.17,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":36624.33},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25266.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41756.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14491.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25054.43},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23558.62},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32029.19},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27413.54},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28840.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13949.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13949.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24873.23},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39790.32},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44761.55},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31711.23},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48059.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14491.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":34832.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14491.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14220.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24972.38},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13543.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13746.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14220.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29925.34},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14356.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26447.67},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13543.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36424.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14220.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26447.67},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30377.82},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13543.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14491.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10432.99,"maximum":36423.2,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":27756.93},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19148.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31646.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11163.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18988.31},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17854.66},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24274.36},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20776.24},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21858.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10745.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10745.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18850.98},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30156.39},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33923.99},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24033.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36423.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11163.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26399.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11163.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10954.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18926.12},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10432.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10589.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10954.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22679.89},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11058.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20044.23},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10432.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27605.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10954.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20044.23},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23022.81},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10432.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11163.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":32708.67,"10th_percentile":32708.67,"90th_percentile":32708.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47487.71,"10th_percentile":47487.71,"90th_percentile":47487.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"1 through 10","median_amount":65198.43,"10th_percentile":65198.43,"90th_percentile":65198.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10434.74,"10th_percentile":10434.74,"90th_percentile":10436.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"1 through 10","median_amount":11493.0,"10th_percentile":11493.0,"90th_percentile":11493.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18154.57,"maximum":65309.31,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":49770.09},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":34335.42},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56744.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19425.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":34047.35},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":32014.64},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43525.6},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":37253.23},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":39193.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18699.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18699.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33801.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54072.48},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60828.05},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":43093.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65309.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19425.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":47335.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19425.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19062.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33935.84},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18154.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18426.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19062.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40666.61},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19243.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35940.68},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18154.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49498.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19062.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":35940.68},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":41281.49},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18154.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19425.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":37253.23,"10th_percentile":37253.23,"90th_percentile":37253.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18658.56,"10th_percentile":18658.56,"90th_percentile":18658.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8358.87,"maximum":28664.01,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":21843.91},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15069.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24904.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8943.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14943.26},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14051.11},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19103.23},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16350.31},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17201.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8609.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8609.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14835.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23732.21},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26697.21},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18913.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28664.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8943.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20775.37},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8943.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8776.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14894.32},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8358.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8484.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8776.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17848.42},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8860.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15774.23},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8358.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21724.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8776.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15774.23},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18118.29},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8358.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8943.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12171.19,"maximum":42925.74,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":32712.31},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22567.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37296.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13023.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22378.25},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21042.21},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28608.0},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24485.37},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25760.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12536.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12536.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22216.4},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35540.12},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39980.35},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28324.0},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42925.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13023.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31112.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13023.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12779.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22304.96},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12171.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12353.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12779.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26728.87},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12901.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23622.67},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12171.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32533.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12779.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23622.67},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27133.01},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12171.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13023.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"1 through 10","median_amount":26728.87,"10th_percentile":26728.87,"90th_percentile":26728.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8055.26,"maximum":27528.25,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":20978.38},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14472.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23917.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8619.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14351.16},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13494.36},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18346.29},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15702.45},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16520.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8296.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8296.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14247.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22791.86},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25639.37},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18164.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27528.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8619.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19952.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8619.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8458.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14304.15},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8055.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8176.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8458.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17141.21},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8538.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15149.2},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8055.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20863.81},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8458.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15149.2},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17400.38},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8055.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8619.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14308.43,"maximum":50921.08,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":38805.29},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26771.01},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44242.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15310.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26546.41},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24961.53},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33936.52},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29046.01},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30558.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14737.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14737.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26354.42},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42159.82},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47427.08},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33599.62},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50921.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15310.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":36907.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15310.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15023.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26459.47},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14308.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14523.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15023.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31707.39},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15166.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28022.62},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14308.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38593.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15023.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":28022.62},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32186.8},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14308.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15310.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"1 through 10","median_amount":38593.37,"10th_percentile":38593.37,"90th_percentile":38593.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13680.19,"maximum":48570.83,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":37014.24},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25535.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42200.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":14364.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30243.94},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14501.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26729.25},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13680.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36812.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14364.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26729.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30701.23},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13680.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14637.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17219.72,"maximum":61812.05,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":47104.95},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32496.79},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53705.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":18080.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38488.95},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18252.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34016.09},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17219.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46847.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18080.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":34016.09},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":39070.9},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17219.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18425.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29713.28,"maximum":108549.92,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":82722.35},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":57068.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":94313.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31793.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":56589.75},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":53211.2},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":72343.44},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":61918.2},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":65142.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30604.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":30604.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":56180.46},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":89873.29},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":101101.66},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":71625.26},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":108549.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31793.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":78675.81},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31793.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31198.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56404.41},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29713.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30158.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31198.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":67591.54},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31496.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":59736.63},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29713.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82270.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31198.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":59736.63},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":68613.52},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29713.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31793.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31204.08,"10th_percentile":31204.08,"90th_percentile":31204.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9530.44,"maximum":33046.83,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":25183.91},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17373.89},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28712.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10197.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17228.13},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16199.57},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22024.17},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18850.32},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19831.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9816.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9816.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17103.53},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27360.94},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30779.29},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21805.53},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33046.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10197.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23951.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10197.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10006.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17171.7},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9530.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9673.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10006.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20577.5},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10102.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18186.16},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9530.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25046.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10006.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18186.16},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20888.64},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9530.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10197.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12890.37,"maximum":45616.15,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":34762.58},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23982.03},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39633.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13792.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23780.83},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22361.05},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30401.03},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26020.01},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27374.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13277.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13277.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23608.83},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37767.64},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42486.16},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30099.23},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45616.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13792.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33062.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13792.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13534.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23702.94},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12890.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13083.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13534.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28404.13},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13663.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25103.24},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12890.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34572.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13534.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25103.24},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28833.6},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12890.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13792.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13451.05,"10th_percentile":13451.05,"90th_percentile":13451.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":26293.55,"10th_percentile":26293.55,"90th_percentile":26293.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25436.54,"maximum":92550.81,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":70529.95},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":48657.24},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80412.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27217.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":48249.02},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":45368.43},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":61680.79},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":52792.12},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":55541.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26199.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26199.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":47900.06},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":76626.92},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":86200.35},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":61068.46},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92550.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27217.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":67079.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27217.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26708.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48091.0},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25436.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25818.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26708.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":57629.26},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26962.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":50932.08},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25436.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70144.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26708.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":50932.08},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":58500.62},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25436.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27217.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15296.65,"maximum":54617.94,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":41622.55},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28714.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47454.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16367.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28473.68},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26773.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36400.3},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31154.74},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32776.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15755.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15755.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28267.74},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45220.61},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50870.28},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":36038.94},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54617.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16367.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":39586.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16367.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16061.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28380.42},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15296.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15526.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16061.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34009.34},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16214.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30057.06},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15296.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41395.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16061.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30057.06},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34523.56},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15296.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16367.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15306.32,"10th_percentile":15306.32,"90th_percentile":15306.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18661.08,"maximum":67204.13,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":51214.07},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":35331.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58390.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19967.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35035.17},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":32943.48},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":44788.41},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":38334.06},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":40330.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19220.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19220.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":34781.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":55641.28},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62592.85},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":44343.78},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67204.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19967.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":48708.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19967.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19594.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34920.42},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18661.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18941.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19594.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":41846.47},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19780.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36983.43},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18661.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50934.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19594.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":36983.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":42479.19},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18661.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19967.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29784.67,"maximum":108816.99,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":82925.88},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":57208.95},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":94545.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31869.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":56728.98},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":53342.12},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":72521.44},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":62070.55},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":65302.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30678.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":30678.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":56318.69},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":90094.41},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":101350.41},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":71801.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":108816.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31869.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":78869.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31869.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31273.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56543.19},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29784.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30231.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31273.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":67757.84},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31571.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":59883.6},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29784.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82473.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31273.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":59883.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":68782.34},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29784.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31869.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13193.22,"maximum":46749.11,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":35625.97},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24577.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40618.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14116.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24371.46},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22916.42},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31156.09},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26666.26},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28054.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13589.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13589.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24195.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38705.66},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43541.37},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30846.8},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46749.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14116.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33883.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14116.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13852.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24291.64},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13193.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13391.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13852.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29109.6},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13984.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25726.73},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13193.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35431.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13852.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25726.73},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29549.73},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13193.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14116.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16710.96,"maximum":59908.8,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":45654.54},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31496.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52051.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17880.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":31231.94},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":29367.31},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39926.42},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":34172.72},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35952.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17212.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17212.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":31006.05},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49601.16},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55798.1},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":39530.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59908.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17880.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":43421.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17880.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17546.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31129.65},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16710.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16961.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17546.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37303.84},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17713.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32968.7},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16710.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45405.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17546.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32968.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":37867.87},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16710.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17880.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34367.27,"maximum":125960.3,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":95990.23},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":66221.79},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":109440.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36772.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":65666.21},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":61745.77},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":83946.65},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":71849.3},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":75590.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35398.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":35398.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":65191.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":104288.12},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":117317.41},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":83113.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125960.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36772.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":91294.67},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36772.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36085.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65451.14},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34367.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34882.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36085.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":78432.59},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36429.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":69317.82},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34367.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95466.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36085.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":69317.82},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":79618.49},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34367.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36772.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17193.41,"maximum":61713.66,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":47029.96},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32445.06},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53619.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18396.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":32172.85},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30252.05},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41129.27},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":35202.23},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":37035.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17709.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17709.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":31940.16},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":51095.48},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":57479.12},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":40720.96},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61713.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18396.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":44729.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18396.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18053.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32067.48},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17193.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17451.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18053.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38427.68},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18225.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33961.94},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17193.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46773.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18053.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33961.94},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":39008.7},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17193.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18396.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26334.57,"maximum":95910.31,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":73090.12},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":50423.45},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83331.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28177.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":50000.41},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":47015.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":63919.74},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":54708.42},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":57557.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27124.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":27124.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":49638.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":79408.4},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":89329.33},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":63285.18},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95910.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28177.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":69514.76},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28177.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27651.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49836.65},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26334.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26729.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27651.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":59721.15},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27914.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":52780.86},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26334.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72690.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27651.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":52780.86},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":60624.13},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26334.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28177.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45848.58,"maximum":168911.34,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":128721.82},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":88802.67},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146758.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49057.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":88057.64},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":82800.38},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":112571.51},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":96349.1},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":101366.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47224.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":47224.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":87420.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":139849.19},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":157321.33},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":111453.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":168911.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49057.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":122425.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49057.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48141.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87769.25},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45848.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46536.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48141.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":105177.21},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48599.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":92954.41},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45848.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128018.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48141.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":92954.41},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":106767.49},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45848.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49057.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Hmo","methodology":"fee schedule","standard_charge_dollar":20638.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":44164.17},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20835.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39031.79},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19656.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53755.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20638.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":39031.79},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":44831.93},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19656.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21031.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24062.06,"maximum":87408.94,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":66611.5},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":45953.98},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75945.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25746.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Hmo","methodology":"fee schedule","standard_charge_dollar":36608.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":79591.44},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36956.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":70342.0},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34864.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96876.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36608.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":70342.0},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":80794.86},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34864.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37305.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30094.29,"maximum":109975.24,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":83808.55},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":57817.88},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95552.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32200.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43759.43,"maximum":161095.92,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":122765.95},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":84693.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139968.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46822.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":116760.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46822.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45947.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83708.22},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43759.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44415.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45947.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":100310.74},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46385.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":88653.47},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43759.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":122095.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45947.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":88653.47},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":101827.43},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43759.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46822.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24574.57,"maximum":89326.25,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":68072.62},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":46961.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77611.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26294.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":46567.97},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":43787.75},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":59531.77},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":50952.79},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":53605.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25311.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25311.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":46231.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":73957.16},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":83197.04},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":58940.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89326.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":25803.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":55621.4},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26049.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":49157.56},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24574.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67700.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25803.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":49157.56},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":56462.4},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24574.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26294.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40479.16,"maximum":148824.6,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":113414.37},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":78242.36},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129306.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":42503.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":92669.66},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42907.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":81900.38},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40479.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":112795.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42503.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":81900.38},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":94070.83},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40479.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43312.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":59830.09,"maximum":221215.57,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":168581.17},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":116300.86},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192203.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64018.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":325212.17,"maximum":1213998.06,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":925148.31},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":638241.78},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1054783.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41519.98,"maximum":152718.25,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":116381.6},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":80289.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":132689.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44426.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":79615.79},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":74862.53},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":101779.57},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":87112.36},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":91648.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42765.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":42765.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":79039.97},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":126442.21},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":142239.34},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":100769.17},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":152718.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44426.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":110688.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44426.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43595.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79355.04},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41519.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42142.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43595.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":95094.15},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44011.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":84043.11},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41519.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":115746.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43595.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":84043.11},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":96531.97},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41519.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44426.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45257.9,"maximum":166701.66,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":127037.89},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":87640.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":144838.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48425.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":86905.68},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":81717.2},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":111098.86},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":95088.67},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":100039.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46615.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":46615.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":86277.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":138019.7},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":155263.26},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":109995.94},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166701.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48425.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":120823.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48425.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47520.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86621.06},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45257.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45936.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47520.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":103801.3},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47973.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":91738.39},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45257.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":126344.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47520.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":91738.39},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":105370.77},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45257.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48425.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22353.16,"maximum":81016.04,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":61739.68},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":42593.0},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70390.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32379.57,"maximum":118524.41,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":90323.58},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":62312.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102980.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":33998.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":73802.43},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34322.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":65225.74},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32379.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89830.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33998.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":65225.74},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":74918.32},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32379.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41683.8,"maximum":153331.11,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":116848.64},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":80611.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":133221.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54621.5,"maximum":201730.45,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":153732.2},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":106056.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":175273.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58445.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":105167.06},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":98888.32},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":134443.92},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":115069.53},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":121061.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56260.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":56260.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":104406.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":167021.59},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":187888.53},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":133109.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":201730.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58445.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":146212.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58445.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57352.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":104822.63},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54621.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55440.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57352.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":125612.92},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57898.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":111015.25},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54621.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":152892.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57352.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":111015.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":127512.19},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54621.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58445.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42814.8,"maximum":157562.12,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":120072.95},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":82835.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":136897.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45811.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":82141.02},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":77236.99},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":105007.79},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":89875.37},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":94555.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44099.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":44099.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":81546.93},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":130452.67},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":146750.85},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":103965.33},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":157562.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":44955.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":98110.32},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45383.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":86708.77},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42814.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":119417.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44955.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":86708.77},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":99593.74},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42814.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45811.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":98016.44,"maximum":364068.97,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":277445.08},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":191403.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":316321.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":104877.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":189798.13},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":178466.71},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":242634.95},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":207669.41},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":218482.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":100956.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":100956.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":188425.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":301428.86},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":339088.04},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":240226.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":364068.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":104877.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":263873.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":104877.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102917.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":189176.52},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":98016.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99486.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102917.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":226697.4},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103897.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":200352.54},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98016.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":275929.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102917.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":200352.54},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":230125.05},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98016.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":104877.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35543.36,"maximum":130359.98,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":99343.09},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":68534.86},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":113263.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38031.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":67959.87},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":63902.5},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":86878.83},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":74358.93},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":78230.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36609.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":36609.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":67468.35},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":107930.81},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":121415.21},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":86016.35},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130359.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38031.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":94483.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38031.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37320.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67737.3},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35543.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36076.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37320.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":81172.17},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37675.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":71739.03},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35543.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98800.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37320.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":71739.03},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":82399.49},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35543.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38031.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":78179.29,"maximum":289859.09,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":220892.15},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":152389.19},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":251844.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83651.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":104788.89,"maximum":389404.41,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":296752.39},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":204723.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":338334.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":112124.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":160202.44,"maximum":596704.05,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":454728.68},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":313708.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":518446.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171416.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":311076.53},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":292504.48},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":397675.35},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":340367.31},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":358090.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":165008.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":165008.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":308826.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":494037.76},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":555760.64},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":393727.46},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":596704.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171416.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":432484.68},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171416.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":168212.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":310057.72},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":160202.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":162605.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":168212.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":371553.92},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169814.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":328375.07},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":160202.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":452245.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":168212.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":328375.07},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":377171.8},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":160202.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171416.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":122997.74,"10th_percentile":122997.74,"90th_percentile":122997.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"1 through 10","median_amount":257384.36,"10th_percentile":257384.36,"90th_percentile":257384.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":85854.28,"maximum":318570.89,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":242772.48},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":167484.0},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":276790.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":90146.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":198366.79},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":91005.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":175314.28},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85854.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241446.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90146.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":175314.28},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":201366.09},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85854.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91864.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System With Mcc","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":211294.16,"maximum":787835.9,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":600384.03},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":414193.24},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":684511.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30910.41,"maximum":113028.32,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":86135.19},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":59422.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98204.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33074.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22491.44,"maximum":81533.32,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":62133.88},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":42864.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70840.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24065.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":42505.33},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":39967.66},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":54338.15},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":46507.61},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":48929.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23166.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23166.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":42197.91},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":67505.06},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":75938.84},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":53798.71},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81533.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24065.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":59094.48},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24065.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23616.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42366.12},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22491.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22828.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23616.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50768.93},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23840.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":44868.99},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22491.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61794.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23616.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":44868.99},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":51536.55},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22491.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24065.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17376.78,"maximum":62399.61,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":47552.71},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32805.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54215.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18593.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":32530.46},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30588.31},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41586.43},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":35593.51},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":37446.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17898.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17898.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":32295.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":51663.41},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":58118.01},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":41173.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62399.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18593.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":45226.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18593.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18245.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32423.92},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17376.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17637.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18245.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38854.81},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18419.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34339.43},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17376.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47293.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18245.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":34339.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":39442.29},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17376.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18593.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27491.87,"maximum":100239.71,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":76389.41},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":52699.57},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87093.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29416.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":52257.43},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":49137.53},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":66805.08},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":57177.96},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":60155.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28316.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":28316.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":51879.48},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":82992.91},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":93361.67},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":66141.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100239.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29416.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":72652.67},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29416.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28866.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52086.28},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27491.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27904.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28866.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":62416.97},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29141.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":55163.4},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27491.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75972.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28866.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":55163.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":63360.71},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27491.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29416.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17058.9,"maximum":61210.43,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":46646.48},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32180.49},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53182.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18253.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":31910.51},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30005.37},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40793.89},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":34915.18},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":36733.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17570.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17570.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":31679.72},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50678.83},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":57010.42},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":40388.92},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61210.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18253.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":44364.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18253.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17911.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31806.0},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17058.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17314.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17911.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38114.33},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18082.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33685.01},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17058.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46391.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17911.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33685.01},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":38690.62},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17058.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18253.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12628.1,"maximum":44635.01,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":34014.88},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23466.21},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38781.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13512.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23269.33},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21880.09},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29747.15},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25460.36},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26786.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13006.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13006.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23101.04},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36955.31},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41572.34},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29451.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44635.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13512.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":32350.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13512.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13259.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23193.12},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12628.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12817.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13259.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27793.2},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13385.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24563.31},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12628.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33829.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13259.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24563.31},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28213.43},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12628.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13512.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25520.7,"maximum":92865.67,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":70769.9},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":48822.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80686.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27307.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":48413.16},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":45522.78},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":61890.63},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":52971.72},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":55729.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26286.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26286.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":48063.02},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":76887.61},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":86493.61},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":61276.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92865.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27307.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":67308.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27307.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26796.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48254.61},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25520.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25903.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26796.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":57825.32},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27051.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":51105.35},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25520.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70383.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26796.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":51105.35},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":58699.64},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25520.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27307.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16496.78,"maximum":59107.58,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":45043.96},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31074.95},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51355.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17651.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30814.24},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28974.55},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39392.44},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33715.69},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35471.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16991.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16991.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30591.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48937.79},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55051.86},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":39001.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59107.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17651.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":42840.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17651.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17321.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30713.32},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16496.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16744.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17321.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36804.94},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17486.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32527.78},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16496.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44797.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17321.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32527.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":37361.43},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16496.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17651.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13175.18,"maximum":46681.64,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":35574.55},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24542.19},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40559.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14097.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24336.29},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22883.35},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31111.13},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26627.78},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28014.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13570.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13570.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24160.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38649.8},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43478.53},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30802.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46681.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14097.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33834.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14097.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13833.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24256.58},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13175.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13372.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13833.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29067.58},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13965.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25689.6},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13175.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35380.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13833.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25689.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29507.09},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13175.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14097.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27469.32,"maximum":100155.37,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":76325.14},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":52655.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87020.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29392.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":52213.47},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":49096.19},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":66748.87},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":57129.85},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":60104.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28293.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":28293.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":51835.83},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":82923.08},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":93283.12},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":66086.23},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100155.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29392.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":72591.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":29117.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":55116.98},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27469.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75908.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28842.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":55116.98},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":63307.4},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27469.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29392.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16227.75,"maximum":58101.14,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":44276.98},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30545.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50481.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17363.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30289.56},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28481.19},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38721.69},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33141.6},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":34867.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":17201.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31973.92},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16227.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44035.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17039.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31973.92},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":36725.26},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16227.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17363.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10941.75,"maximum":38326.45,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":29207.34},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20149.57},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33299.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11707.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19980.52},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18787.64},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25542.79},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21861.88},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23000.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11270.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11270.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19836.02},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31732.17},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35696.65},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25289.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38326.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11707.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27778.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11707.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11488.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19915.09},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10941.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11105.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11488.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23865.0},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11598.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21091.61},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10941.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29047.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11488.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21091.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24225.84},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10941.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11707.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18630.27,"maximum":67088.86,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":51126.23},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":35270.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58290.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19934.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":34975.08},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":32886.98},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":44711.59},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":38268.31},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":40260.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19189.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19189.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":34722.12},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":55545.85},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62485.5},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":44267.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67088.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19934.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":48625.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19934.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19561.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34860.53},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18630.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18909.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19561.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":41774.7},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19748.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36919.99},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18630.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50847.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19561.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":36919.99},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":42406.33},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18630.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19934.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18526.18,"10th_percentile":18526.18,"90th_percentile":18526.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18630.39,"10th_percentile":18630.39,"90th_percentile":18630.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":5903.19,"10th_percentile":5903.19,"90th_percentile":5903.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13408.9,"maximum":47555.95,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":36240.84},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25001.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41319.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14347.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24792.09},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23311.94},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31693.82},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27126.5},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28538.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13811.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13811.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24612.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39373.68},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44292.85},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31379.18},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47555.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14347.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":34468.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14347.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14079.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24710.89},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13408.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13610.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14079.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29612.0},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14213.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26170.74},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13408.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36042.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14079.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26170.74},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30059.73},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13408.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14347.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":31693.82,"10th_percentile":31693.82,"90th_percentile":31693.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13263.76,"10th_percentile":13263.76,"90th_percentile":13628.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13408.17,"10th_percentile":12696.5,"90th_percentile":13424.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10960.53,"maximum":38396.74,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":29260.9},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20186.52},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33361.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11727.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20017.16},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18822.09},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25589.63},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21901.97},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23042.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11289.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11289.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19872.39},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31790.36},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35762.11},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25335.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38396.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11727.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27829.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11727.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11508.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19951.61},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10960.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11124.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11508.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23908.77},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11618.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21130.29},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10960.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29101.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11508.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21130.29},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24270.27},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10960.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11727.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26300.75,"maximum":95783.8,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":72993.71},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":50356.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83221.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28141.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":49934.46},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":46953.25},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":63835.43},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":54636.26},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":57481.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27089.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":27089.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":49573.31},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":79303.66},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":89211.51},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":63201.71},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95783.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28141.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":69423.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28141.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27615.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49770.92},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26300.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26695.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27615.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":59642.38},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27878.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":52711.24},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26300.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72595.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27615.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":52711.24},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":60544.17},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26300.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28141.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13753.83,"maximum":48846.34,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":37224.2},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25680.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42440.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14716.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25464.8},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23944.49},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32553.8},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27862.55},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29313.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14166.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14166.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25280.63},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40442.05},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45494.7},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32230.63},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48846.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14716.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35403.3},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14716.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14441.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25381.4},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13753.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13960.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14441.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30415.49},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14579.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26880.86},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13753.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37020.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14441.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26880.86},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30875.38},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13753.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14716.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11213.79,"maximum":39344.14,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":29982.89},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20684.61},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34184.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11998.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20511.07},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19286.51},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26221.03},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22442.38},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23610.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11550.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11550.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20362.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32574.76},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36644.51},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25960.73},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39344.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11998.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28516.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11998.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11774.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20443.9},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11213.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11382.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11774.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24498.7},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11886.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21651.66},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11213.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29819.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11774.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21651.66},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24869.12},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11213.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11998.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31906.13,"maximum":116753.29,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":88973.87},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":61381.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101441.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34139.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":60866.37},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":57232.49},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":77810.61},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":66597.51},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":70065.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":33820.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":64251.06},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31906.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88487.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33501.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":64251.06},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":73798.81},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31906.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34139.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17138.56,"maximum":61508.43,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":46873.57},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32337.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53441.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18338.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":32065.86},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30151.45},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40992.49},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":35085.16},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":36912.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18338.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11971.29,"maximum":42177.93,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":32142.43},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22174.43},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36646.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12809.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21988.4},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20675.63},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28109.62},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24058.81},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25311.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12809.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":83520.14,"maximum":309839.0,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":236118.19},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":162893.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":269203.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":87696.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":192929.63},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":88531.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":170508.99},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83520.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":234828.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87696.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":170508.99},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":195846.72},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83520.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89366.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54943.89,"maximum":202936.5,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":154651.29},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":106690.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":176321.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":57691.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":126363.9},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58240.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":111678.96},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54943.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":153806.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57691.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":111678.96},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":128274.52},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54943.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58789.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42945.56,"maximum":158051.29,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":120445.73},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":83093.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":137322.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":45092.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":98414.91},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45522.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":86977.96},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42945.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":119787.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45092.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":86977.96},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":99902.94},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42945.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45951.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":68403.12,"maximum":253286.88,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":193021.67},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":133161.89},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":220068.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":71823.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":157715.93},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72507.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":139387.52},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68403.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":191967.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71823.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":139387.52},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":160100.59},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68403.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73191.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44035.98,"maximum":162130.48,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":123554.35},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":85237.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":140867.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":46237.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":100954.93},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46678.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":89222.8},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44035.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":122879.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46237.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":89222.8},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":102481.37},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44035.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47118.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15487.53,"maximum":55332.01,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":42166.72},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29090.0},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48075.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16571.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28845.94},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27123.76},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36876.2},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31562.06},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33205.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15952.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15952.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28637.31},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45811.82},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51535.35},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":36510.11},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55332.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":16261.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34453.97},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16416.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30450.02},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15487.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41936.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16261.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30450.02},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34974.91},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15487.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16571.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15873.75,"10th_percentile":15873.75,"90th_percentile":15873.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":5265.39,"10th_percentile":5265.39,"90th_percentile":5265.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8633.91,"maximum":29692.95,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":22628.03},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15610.64},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25798.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9238.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15479.67},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14555.49},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19788.96},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16937.22},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17819.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8892.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8892.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15367.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24584.11},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27655.54},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19592.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29692.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9238.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21521.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9238.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9065.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15428.97},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8633.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8763.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9065.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18489.12},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9151.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16340.47},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8633.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22504.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9065.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16340.47},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18768.67},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8633.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9238.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":15367.71,"10th_percentile":15367.71,"90th_percentile":15367.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1050.0,"10th_percentile":1050.0,"90th_percentile":1050.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9022.72,"10th_percentile":9022.72,"90th_percentile":9022.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6051.03,"maximum":20030.51,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":15264.6},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10530.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17403.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6474.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":10442.4},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9818.96},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":13349.4},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11425.65},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12020.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6232.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6232.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10366.88},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16584.15},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18656.1},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13216.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20030.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6474.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14517.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6474.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6353.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10408.2},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6051.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6141.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6353.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12472.54},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6414.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11023.09},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6051.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15181.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6353.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11023.09},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12661.13},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6051.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6474.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14499.31,"maximum":51635.15,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":39349.46},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27146.43},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44863.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15514.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9196.78,"maximum":31798.61,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":24232.69},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16717.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27628.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9840.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16577.4},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15587.69},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21192.29},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18138.32},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19082.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9472.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9472.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16457.51},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26327.48},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29616.72},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20981.91},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31798.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9840.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23047.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9840.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9656.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16523.11},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9196.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9334.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9656.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19800.27},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9748.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17499.25},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9196.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24100.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9656.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17499.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20099.65},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9196.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9840.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9427.63,"10th_percentile":9427.63,"90th_percentile":9427.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9197.44,"10th_percentile":9197.44,"90th_percentile":9197.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7109.14,"maximum":23988.82,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":18281.1},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12611.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20842.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7606.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12505.96},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11759.33},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15987.43},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13683.52},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14396.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7322.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7322.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12415.52},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19861.41},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22342.81},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15828.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23988.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7606.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17386.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7606.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7464.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12465.01},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7109.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7215.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7464.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14937.29},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7535.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13201.4},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7109.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18181.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7464.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13201.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15163.14},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7109.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7606.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12947.48,"maximum":45829.81,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":34925.4},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24094.36},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39819.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13853.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23892.21},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22465.79},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30543.43},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26141.89},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27503.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13335.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13335.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23719.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37944.54},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42685.16},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30240.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45829.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13853.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33216.96},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13853.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13594.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23813.96},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12947.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13141.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13594.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28537.17},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13724.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25220.82},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12947.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34734.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13594.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25220.82},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28968.65},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12947.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13853.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":10409.17,"10th_percentile":10409.17,"90th_percentile":10409.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2995.56,"10th_percentile":2995.56,"90th_percentile":2995.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"1 through 10","median_amount":34734.67,"10th_percentile":34734.67,"90th_percentile":34734.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7018.21,"maximum":23648.66,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":18021.87},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12432.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20547.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7509.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12328.63},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11592.58},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15760.72},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13489.48},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14191.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7228.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7228.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12239.46},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19579.77},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22025.98},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15604.26},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23648.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7509.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17140.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7509.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7369.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12288.25},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7018.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7123.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7369.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14725.48},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7439.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13014.21},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7018.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17923.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7369.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13014.21},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14948.12},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7018.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7509.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7345.18,"10th_percentile":7345.18,"90th_percentile":7345.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":13008.1,"10th_percentile":13008.1,"90th_percentile":13008.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6965.24,"10th_percentile":6965.24,"90th_percentile":6965.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"1 through 10","median_amount":14725.48,"10th_percentile":14725.48,"90th_percentile":14725.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2995.56,"10th_percentile":2995.56,"90th_percentile":2995.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5366.42,"maximum":17469.42,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":13312.87},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9184.29},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15178.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5742.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":9107.24},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":8563.51},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":11642.55},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":9964.77},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":10483.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5527.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5527.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9041.37},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":14463.71},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16270.74},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11526.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17469.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5742.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12661.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5742.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5634.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9077.41},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5366.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5446.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5634.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10877.81},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5688.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":9613.68},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5366.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13240.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5634.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":9613.68},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":11042.28},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5366.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5742.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":11642.55,"10th_percentile":11642.55,"90th_percentile":11642.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2160.17,"10th_percentile":2160.17,"90th_percentile":2160.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7914.74,"maximum":27002.54,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":20577.75},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14196.19},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23461.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8468.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14077.09},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13236.65},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17995.93},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15402.58},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16204.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8152.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8152.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13975.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22356.6},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25149.73},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17817.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27002.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8468.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19571.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8468.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8310.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14030.98},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7914.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8033.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8310.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16813.86},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8389.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14859.9},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7914.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20465.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8310.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14859.9},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17068.09},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7914.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8468.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11457.27,"maximum":40255.0,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":30677.03},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21163.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34975.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12259.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20985.93},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19733.01},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26828.08},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22961.95},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24157.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11800.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11800.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20834.15},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33328.9},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37492.87},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26561.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40255.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12259.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29176.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12259.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12030.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20917.2},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11457.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11629.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12030.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25065.87},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12144.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22152.92},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11457.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30509.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12030.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22152.92},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25444.86},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11457.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12259.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8053.76,"maximum":27522.63,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":20974.1},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14469.62},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23913.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8617.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14348.22},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13491.6},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18342.54},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15699.24},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16516.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8295.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8295.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14244.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22787.2},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25634.14},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18160.45},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27522.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":8456.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17137.71},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8536.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15146.11},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8053.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20859.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8456.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15146.11},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17396.83},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8053.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8617.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4150.33,"10th_percentile":4150.33,"90th_percentile":4150.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5683.55,"maximum":18655.79,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":14216.97},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9808.01},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16209.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6081.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":9725.72},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9145.07},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":12433.21},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10641.49},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11195.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5854.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5854.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9655.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":15445.95},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17375.7},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12309.78},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18655.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6081.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13521.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6081.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5967.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9693.87},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5683.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5768.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5967.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11616.53},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6024.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10266.56},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5683.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14139.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5967.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10266.56},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":11792.17},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5683.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6081.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8267.94,"maximum":28323.85,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":21584.68},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14890.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24609.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8846.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14765.92},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13884.36},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18876.52},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16156.27},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16997.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8515.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8515.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14659.13},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23450.57},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26380.38},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18689.13},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28323.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8846.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20528.82},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8846.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8681.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14717.56},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8267.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8391.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8681.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17636.61},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8764.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15587.03},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8267.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21466.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8681.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15587.03},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17903.28},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8267.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8846.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4983.91,"maximum":16038.47,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":12222.39},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":8431.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13935.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8749.64,"maximum":30125.89,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":22957.96},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15838.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26174.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9362.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15705.37},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14767.72},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20077.5},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17184.18},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18078.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - 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Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9362.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"1 through 10","median_amount":11854.47,"10th_percentile":11854.47,"90th_percentile":11854.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2200.03,"10th_percentile":2200.03,"90th_percentile":2200.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13395.37,"maximum":47505.35,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":36202.28},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24975.24},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41275.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14333.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24765.71},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23287.13},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31660.09},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27097.63},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28508.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13797.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13797.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24586.59},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39331.78},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44245.72},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31345.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47505.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14333.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":34431.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14333.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14065.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24684.6},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13395.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13596.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14065.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29580.49},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14199.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26142.9},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13395.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36004.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14065.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26142.9},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30027.75},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13395.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14333.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":12057.47,"10th_percentile":12057.47,"90th_percentile":12057.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2528.25,"10th_percentile":2528.25,"90th_percentile":2528.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8231.87,"maximum":28188.91,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":21481.84},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14819.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24491.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8808.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14695.57},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13818.21},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18786.59},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16079.3},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16916.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8478.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8478.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14589.29},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23338.85},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26254.7},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18600.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28188.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8808.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20431.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8808.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8643.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14647.44},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8231.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8355.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8643.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17552.58},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8725.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15512.77},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8231.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21364.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8643.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15512.77},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17817.98},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8231.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8808.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5616.67,"maximum":18405.58,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":14026.29},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9676.47},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15991.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6009.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":9595.28},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9022.42},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":12266.46},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10498.77},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11045.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5785.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5785.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9525.89},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":15238.8},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17142.66},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12144.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18405.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6009.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13340.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - 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Hmo","methodology":"fee schedule","standard_charge_dollar":5953.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10128.86},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5616.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13949.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5897.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10128.86},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":11634.02},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5616.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6009.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1519.99,"10th_percentile":1519.99,"90th_percentile":1519.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7018.96,"maximum":23651.47,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":18024.01},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12434.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20549.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7510.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12330.09},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11593.96},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15762.6},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13491.09},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14193.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7229.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7229.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12240.92},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19582.1},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22028.6},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15606.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23651.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7510.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17142.33},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7510.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7369.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12289.71},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7018.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7124.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7369.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14727.23},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7440.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13015.75},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7018.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17925.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7369.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13015.75},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14949.9},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7018.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7510.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"1 through 10","median_amount":8298.65,"10th_percentile":8298.65,"90th_percentile":8298.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19146.54,"maximum":69020.23,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":52598.06},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":36286.38},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59968.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20486.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35981.95},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":33833.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":45998.75},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":39369.98},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":41419.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19720.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19720.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":35721.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":57144.91},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64284.34},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":45542.11},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69020.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20486.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":50025.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20486.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20103.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35864.1},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19146.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19433.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20103.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":42977.31},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20295.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":37982.85},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19146.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52310.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20103.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":37982.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":43627.13},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19146.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20486.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8663.22,"maximum":29802.59,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":22711.58},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15668.28},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25894.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9269.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15536.83},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14609.24},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19862.03},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16999.76},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17884.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8923.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8923.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15424.46},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24674.89},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27757.66},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19664.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29802.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9269.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21600.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9269.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9096.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15485.94},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8663.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8793.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9096.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18557.39},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9183.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16400.81},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8663.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22587.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9096.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16400.81},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18837.98},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8663.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9269.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":20271.76,"10th_percentile":20271.76,"90th_percentile":20271.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3255.88,"10th_percentile":3255.88,"90th_percentile":3255.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7894.45,"maximum":26926.63,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":20519.91},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14156.28},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23395.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8447.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14037.52},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13199.44},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17945.34},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15359.28},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16159.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8131.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8131.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13935.99},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22293.75},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25079.04},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17767.19},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26926.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8447.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19516.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8447.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8289.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13991.54},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7894.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8012.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8289.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16766.6},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14818.12},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7894.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20407.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8289.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14818.12},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17020.11},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7894.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8447.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"1 through 10","median_amount":14925.59,"10th_percentile":14925.59,"90th_percentile":14925.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13092.52,"maximum":46372.39,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":35338.89},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24379.61},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40290.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14009.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24175.07},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22731.76},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30905.03},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26451.38},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27828.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13485.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13485.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24000.23},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38393.76},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43190.51},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30598.23},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46372.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14009.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33610.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14009.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13747.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24095.9},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13092.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13288.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13747.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28875.03},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13878.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25519.41},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13092.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35145.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13747.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25519.41},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29311.62},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13092.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14009.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3965.49,"10th_percentile":3965.49,"90th_percentile":3965.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9089.32,"maximum":31396.6,"payers_information":[{"payer_name":"Adventhealth","plan_name":"Amps Hmo","methodology":"fee schedule","standard_charge_dollar":23926.32},{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16506.3},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27278.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9725.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16367.82},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15390.62},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20924.36},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17909.0},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18841.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9362.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9362.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16249.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25994.64},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29242.29},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20716.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31396.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9725.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22755.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9725.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9543.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16314.21},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9089.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9225.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9543.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19549.94},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9634.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17278.01},{"payer_name":"Unitedhealthcare","plan_name":"Global Transplant Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9089.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23795.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9543.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17278.01},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19845.54},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9089.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9725.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":9051.83,"10th_percentile":9051.83,"90th_percentile":9051.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":18318.73,"10th_percentile":18318.73,"90th_percentile":18318.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":16365.67,"10th_percentile":16365.67,"90th_percentile":16365.67},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"1 through 10","median_amount":14925.59,"10th_percentile":14925.59,"90th_percentile":14925.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":9138.04,"10th_percentile":9138.04,"90th_percentile":9138.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4146.29,"10th_percentile":4146.29,"90th_percentile":4146.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"0764","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":6481.2,"10th_percentile":6481.2,"90th_percentile":6481.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, methylpred acetate 1 mg","code_information":[{"code":"0790","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":1382.04,"10th_percentile":1382.04,"90th_percentile":1382.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":653.75,"10th_percentile":653.75,"90th_percentile":653.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":1330.59,"10th_percentile":1330.59,"90th_percentile":1330.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":89.76,"10th_percentile":89.76,"90th_percentile":853.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":135.65,"10th_percentile":135.65,"90th_percentile":135.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":363.67,"10th_percentile":170.3,"90th_percentile":1230.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":133.24,"10th_percentile":133.24,"90th_percentile":133.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"1 through 10","median_amount":197.46,"10th_percentile":197.46,"90th_percentile":197.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":785.03,"10th_percentile":328.13,"90th_percentile":2485.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":166.13,"10th_percentile":166.13,"90th_percentile":201.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":129.99,"10th_percentile":129.99,"90th_percentile":129.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"21","median_amount":169.35,"10th_percentile":90.0,"90th_percentile":254.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":276.32,"10th_percentile":276.32,"90th_percentile":364.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":121.64,"10th_percentile":59.77,"90th_percentile":194.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":135.83,"10th_percentile":135.83,"90th_percentile":135.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":165.83,"10th_percentile":165.83,"90th_percentile":165.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":131.6,"10th_percentile":95.45,"90th_percentile":877.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":132.28,"10th_percentile":132.28,"90th_percentile":132.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":89.71,"10th_percentile":89.71,"90th_percentile":89.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":180.74,"10th_percentile":180.74,"90th_percentile":180.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":86.49,"10th_percentile":86.49,"90th_percentile":86.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":85.67,"10th_percentile":85.67,"90th_percentile":85.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":239.06,"10th_percentile":239.06,"90th_percentile":239.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":160.72,"10th_percentile":120.37,"90th_percentile":161.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":611.01,"10th_percentile":611.01,"90th_percentile":611.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":166.69,"10th_percentile":166.69,"90th_percentile":166.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"13","median_amount":470.84,"10th_percentile":470.84,"90th_percentile":719.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":672.0,"10th_percentile":672.0,"90th_percentile":672.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":114.07,"10th_percentile":72.25,"90th_percentile":176.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":160.98,"10th_percentile":160.73,"90th_percentile":349.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":325.07,"10th_percentile":325.07,"90th_percentile":333.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":158.51,"10th_percentile":158.51,"90th_percentile":158.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"58","median_amount":105.33,"10th_percentile":84.58,"90th_percentile":199.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":467.24,"10th_percentile":467.24,"90th_percentile":467.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"41","median_amount":59.77,"10th_percentile":59.77,"90th_percentile":59.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":165.77,"10th_percentile":165.77,"90th_percentile":165.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"13","median_amount":191.6,"10th_percentile":115.24,"90th_percentile":227.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"32","median_amount":1213.23,"10th_percentile":745.69,"90th_percentile":2017.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":292.75,"10th_percentile":292.45,"90th_percentile":293.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"78","median_amount":1251.36,"10th_percentile":823.97,"90th_percentile":1830.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":286.28,"10th_percentile":286.28,"90th_percentile":449.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"38","median_amount":1657.87,"10th_percentile":1180.38,"90th_percentile":2470.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":297.4,"10th_percentile":297.4,"90th_percentile":297.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"61","median_amount":144.51,"10th_percentile":94.67,"90th_percentile":255.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":280.69,"10th_percentile":280.54,"90th_percentile":280.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":120.73,"10th_percentile":120.73,"90th_percentile":120.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":568.39,"10th_percentile":568.39,"90th_percentile":568.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"29","median_amount":132.9,"10th_percentile":116.34,"90th_percentile":211.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"300","median_amount":169.35,"10th_percentile":105.33,"90th_percentile":285.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"26","median_amount":928.04,"10th_percentile":781.96,"90th_percentile":1757.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"136","median_amount":149.63,"10th_percentile":119.54,"90th_percentile":557.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":288.2,"10th_percentile":288.2,"90th_percentile":291.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":297.97,"10th_percentile":161.1,"90th_percentile":499.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"72","median_amount":3577.06,"10th_percentile":2329.51,"90th_percentile":7189.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"24","median_amount":672.46,"10th_percentile":450.2,"90th_percentile":906.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"1 through 10","median_amount":4712.92,"10th_percentile":4712.92,"90th_percentile":4712.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"164","median_amount":3488.54,"10th_percentile":1997.1,"90th_percentile":7307.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"21","median_amount":672.41,"10th_percentile":440.25,"90th_percentile":864.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"1 through 10","median_amount":3390.11,"10th_percentile":3282.28,"90th_percentile":7367.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"67","median_amount":4843.5,"10th_percentile":2972.87,"90th_percentile":8627.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"14","median_amount":724.17,"10th_percentile":457.35,"90th_percentile":896.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1053.46,"10th_percentile":1053.46,"90th_percentile":1053.46},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"40","median_amount":295.56,"10th_percentile":127.72,"90th_percentile":689.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"87","median_amount":657.24,"10th_percentile":430.9,"90th_percentile":946.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":1092.37,"10th_percentile":874.09,"90th_percentile":2104.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":248.43,"10th_percentile":116.34,"90th_percentile":1227.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"203","median_amount":272.1,"10th_percentile":115.24,"90th_percentile":508.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"42","median_amount":3124.14,"10th_percentile":2329.26,"90th_percentile":7041.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"124","median_amount":261.94,"10th_percentile":144.75,"90th_percentile":616.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"85","median_amount":685.47,"10th_percentile":442.02,"90th_percentile":986.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":488.83,"10th_percentile":248.6,"90th_percentile":1015.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"75","median_amount":5516.24,"10th_percentile":2489.12,"90th_percentile":13904.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"55","median_amount":1198.93,"10th_percentile":740.81,"90th_percentile":2997.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"211","median_amount":6777.29,"10th_percentile":3662.78,"90th_percentile":13668.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"34","median_amount":1222.6,"10th_percentile":871.82,"90th_percentile":2836.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"1 through 10","median_amount":7999.78,"10th_percentile":4290.92,"90th_percentile":30992.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"76","median_amount":9808.65,"10th_percentile":5459.02,"90th_percentile":17816.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"15","median_amount":1225.73,"10th_percentile":867.28,"90th_percentile":3038.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"23","median_amount":571.64,"10th_percentile":127.48,"90th_percentile":869.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"138","median_amount":1162.88,"10th_percentile":727.06,"90th_percentile":1793.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"54","median_amount":2340.48,"10th_percentile":1691.03,"90th_percentile":5451.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":605.93,"10th_percentile":182.45,"90th_percentile":955.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"159","median_amount":400.48,"10th_percentile":130.2,"90th_percentile":726.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"74","median_amount":7176.04,"10th_percentile":3326.67,"90th_percentile":12490.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"81","median_amount":341.38,"10th_percentile":248.02,"90th_percentile":736.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"142","median_amount":1316.26,"10th_percentile":873.97,"90th_percentile":2851.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2796.53,"10th_percentile":2796.53,"90th_percentile":2796.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":19419.37,"10th_percentile":19419.37,"90th_percentile":19419.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":934.01,"10th_percentile":934.01,"90th_percentile":934.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1880.86,"10th_percentile":1410.01,"90th_percentile":2197.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":10.0,"10th_percentile":10.0,"90th_percentile":10.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":130.37,"10th_percentile":130.37,"90th_percentile":704.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":828.47,"10th_percentile":828.47,"90th_percentile":828.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2948.64,"10th_percentile":2948.64,"90th_percentile":2948.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":211.14,"10th_percentile":209.14,"90th_percentile":213.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":447.08,"10th_percentile":218.02,"90th_percentile":7822.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":205.43,"10th_percentile":205.43,"90th_percentile":205.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":1783.97,"10th_percentile":1783.97,"90th_percentile":2040.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":200.42,"10th_percentile":200.42,"90th_percentile":200.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":407.88,"10th_percentile":407.88,"90th_percentile":407.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":182.35,"10th_percentile":182.35,"90th_percentile":182.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":353.73,"10th_percentile":353.73,"90th_percentile":353.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":206.07,"10th_percentile":206.07,"90th_percentile":339.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":375.11,"10th_percentile":375.11,"90th_percentile":493.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":420.53,"10th_percentile":420.53,"90th_percentile":556.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"11","median_amount":526.33,"10th_percentile":526.33,"90th_percentile":526.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":413.07,"10th_percentile":413.07,"90th_percentile":523.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":2154.15,"10th_percentile":2154.15,"90th_percentile":2219.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":838.2,"10th_percentile":838.2,"90th_percentile":838.2},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":403.44,"10th_percentile":403.44,"90th_percentile":532.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":820.13,"10th_percentile":820.13,"90th_percentile":820.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":266.75,"10th_percentile":266.75,"90th_percentile":678.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":1154.79,"10th_percentile":1154.79,"90th_percentile":1154.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":59.77,"10th_percentile":59.77,"90th_percentile":239.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":414.35,"10th_percentile":412.67,"90th_percentile":556.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":5729.89,"10th_percentile":5729.89,"90th_percentile":5729.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":13232.93,"10th_percentile":13232.93,"90th_percentile":13232.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":119.54,"10th_percentile":119.54,"90th_percentile":119.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyperbaric Oxygen","code_information":[{"code":"5061","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":2488.51,"10th_percentile":2488.51,"90th_percentile":2488.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":740.58,"10th_percentile":740.58,"90th_percentile":745.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":1097.74,"10th_percentile":1097.74,"90th_percentile":6929.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":727.44,"10th_percentile":727.44,"90th_percentile":727.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"1 through 10","median_amount":882.86,"10th_percentile":882.86,"90th_percentile":882.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":2084.18,"10th_percentile":2084.18,"90th_percentile":11260.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":712.62,"10th_percentile":710.42,"90th_percentile":790.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":179.31,"10th_percentile":179.31,"90th_percentile":179.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":729.69,"10th_percentile":729.69,"90th_percentile":729.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":3465.1,"10th_percentile":2331.03,"90th_percentile":10271.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1707.41,"10th_percentile":1707.41,"90th_percentile":1710.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"14","median_amount":3027.65,"10th_percentile":1377.25,"90th_percentile":6288.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":1757.87,"10th_percentile":1757.87,"90th_percentile":1757.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":6867.19,"10th_percentile":6867.19,"90th_percentile":6867.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":2985.3,"10th_percentile":2985.3,"90th_percentile":2985.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1206.68,"10th_percentile":1206.68,"90th_percentile":1206.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":1636.0,"10th_percentile":1634.25,"90th_percentile":1637.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3325.91,"10th_percentile":3325.91,"90th_percentile":3325.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":8929.09,"10th_percentile":3083.03,"90th_percentile":14968.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":404.12,"10th_percentile":404.12,"90th_percentile":404.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1680.36,"10th_percentile":1680.36,"90th_percentile":1707.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2575.09,"10th_percentile":2575.09,"90th_percentile":2575.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":6956.72,"10th_percentile":6956.72,"90th_percentile":6956.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":2959.06,"10th_percentile":2959.06,"90th_percentile":2959.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":6994.51,"10th_percentile":6994.51,"90th_percentile":6994.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":3959.06,"10th_percentile":3959.06,"90th_percentile":3959.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3865.35,"10th_percentile":3865.35,"90th_percentile":3869.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":14274.65,"10th_percentile":14274.65,"90th_percentile":32689.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6763.45,"10th_percentile":6763.45,"90th_percentile":6763.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5092","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":24297.5,"10th_percentile":24297.5,"90th_percentile":24297.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"1 through 10","median_amount":25281.03,"10th_percentile":25281.03,"90th_percentile":25281.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":45883.83,"10th_percentile":45883.83,"90th_percentile":45883.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":165.55,"10th_percentile":165.55,"90th_percentile":165.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":312.71,"10th_percentile":312.71,"90th_percentile":312.71},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":126.92,"10th_percentile":126.92,"90th_percentile":126.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":59.77,"10th_percentile":59.77,"90th_percentile":59.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Musculoskeletal Procedures","code_information":[{"code":"5111","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":972.64,"10th_percentile":972.64,"90th_percentile":972.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":1251.67,"10th_percentile":1251.67,"90th_percentile":1251.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1894.55,"10th_percentile":1894.55,"90th_percentile":1894.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":1654.65,"10th_percentile":1654.65,"90th_percentile":1654.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":13144.45,"10th_percentile":13144.45,"90th_percentile":13144.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1615.0,"10th_percentile":1615.0,"90th_percentile":1615.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":534.0,"10th_percentile":534.0,"90th_percentile":534.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":239.08,"10th_percentile":239.08,"90th_percentile":239.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8.42,"10th_percentile":8.42,"90th_percentile":8.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":11113.89,"10th_percentile":11113.89,"90th_percentile":11149.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"1 through 10","median_amount":7418.23,"10th_percentile":7418.23,"90th_percentile":7418.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":18216.73,"10th_percentile":18216.73,"90th_percentile":18216.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":3493.27,"10th_percentile":3493.27,"90th_percentile":3493.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3282.36,"10th_percentile":3282.36,"90th_percentile":3282.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2201.71,"10th_percentile":2201.71,"90th_percentile":2201.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":20480.44,"10th_percentile":20480.44,"90th_percentile":20480.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":421.54,"10th_percentile":421.54,"90th_percentile":421.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3373.25,"10th_percentile":3373.25,"90th_percentile":3427.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":6477.89,"10th_percentile":6477.89,"90th_percentile":14518.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7525.36,"10th_percentile":7525.36,"90th_percentile":7525.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":17435.15,"10th_percentile":12827.41,"90th_percentile":22653.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":7393.95,"10th_percentile":7393.95,"90th_percentile":7587.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":22640.62,"10th_percentile":22640.62,"90th_percentile":22640.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":7890.3,"10th_percentile":7890.3,"90th_percentile":7890.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15065.21,"10th_percentile":15065.21,"90th_percentile":15065.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3994.08,"10th_percentile":3994.08,"90th_percentile":3994.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":31116.86,"10th_percentile":31116.86,"90th_percentile":31116.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":418.39,"10th_percentile":418.39,"90th_percentile":418.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7417.06,"10th_percentile":7417.06,"90th_percentile":7734.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":895.44,"10th_percentile":895.44,"90th_percentile":895.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13543.15,"10th_percentile":13543.15,"90th_percentile":13543.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":21664.09,"10th_percentile":20482.9,"90th_percentile":23436.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":13302.92,"10th_percentile":13302.92,"90th_percentile":13302.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":40865.95,"10th_percentile":40865.95,"90th_percentile":45103.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":14221.19,"10th_percentile":14221.19,"90th_percentile":14244.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13182.47,"10th_percentile":13178.02,"90th_percentile":13184.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":45978.01,"10th_percentile":45978.01,"90th_percentile":47801.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13963.0,"10th_percentile":13753.36,"90th_percentile":14081.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":0.61,"10th_percentile":0.61,"90th_percentile":0.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19462.27,"10th_percentile":19462.27,"90th_percentile":19462.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":1782.92,"10th_percentile":1782.92,"90th_percentile":1782.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1741.14,"10th_percentile":1741.14,"90th_percentile":1741.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1792.59,"10th_percentile":1792.59,"90th_percentile":1796.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Airway Endoscopy","code_information":[{"code":"5154","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7295.96,"10th_percentile":7295.96,"90th_percentile":7295.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":14362.55,"10th_percentile":14362.55,"90th_percentile":14362.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":13095.24,"10th_percentile":13095.24,"90th_percentile":13095.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3719.59,"10th_percentile":3718.84,"90th_percentile":3728.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2611.7,"10th_percentile":2611.7,"90th_percentile":2611.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":13213.72,"10th_percentile":13213.72,"90th_percentile":13213.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7179.33,"10th_percentile":7179.33,"90th_percentile":7296.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Airway Endoscopy","code_information":[{"code":"5155","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7296.07,"10th_percentile":7296.07,"90th_percentile":7296.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 ENT Procedures","code_information":[{"code":"5164","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":1597.57,"10th_percentile":1597.57,"90th_percentile":1597.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":650.76,"10th_percentile":650.76,"90th_percentile":650.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":4392.72,"10th_percentile":4392.72,"90th_percentile":4392.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":639.22,"10th_percentile":639.22,"90th_percentile":639.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":624.46,"10th_percentile":624.46,"90th_percentile":624.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":498.89,"10th_percentile":498.89,"90th_percentile":498.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":2098.79,"10th_percentile":2098.79,"90th_percentile":2098.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":638.6,"10th_percentile":638.6,"90th_percentile":1389.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":3043.17,"10th_percentile":3043.17,"90th_percentile":3043.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1640.09,"10th_percentile":1640.09,"90th_percentile":1640.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":9056.88,"10th_percentile":9056.88,"90th_percentile":9056.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1566.87,"10th_percentile":1566.87,"90th_percentile":1568.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1611.08,"10th_percentile":1611.08,"90th_percentile":1611.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":24319.77,"10th_percentile":24319.77,"90th_percentile":24319.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":6041.4,"10th_percentile":6041.4,"90th_percentile":6041.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":3262.28,"10th_percentile":3262.28,"90th_percentile":3369.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3177.67,"10th_percentile":3176.22,"90th_percentile":3184.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6460.97,"10th_percentile":6460.97,"90th_percentile":6460.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1450.06,"10th_percentile":1450.06,"90th_percentile":1450.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":14404.85,"10th_percentile":14404.85,"90th_percentile":14404.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3269.27,"10th_percentile":3264.29,"90th_percentile":3325.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6022.25,"10th_percentile":6022.25,"90th_percentile":6022.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":7099.11,"10th_percentile":5475.42,"90th_percentile":8251.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":3325.43,"10th_percentile":3325.43,"90th_percentile":6007.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"1 through 10","median_amount":7680.01,"10th_percentile":7680.01,"90th_percentile":7680.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":6123.68,"10th_percentile":6123.68,"90th_percentile":6123.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3245.98,"10th_percentile":3244.23,"90th_percentile":3260.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":15995.79,"10th_percentile":15995.79,"90th_percentile":15995.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3404.06,"10th_percentile":3404.06,"90th_percentile":3404.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":12987.67,"10th_percentile":12987.67,"90th_percentile":12987.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":5894.76,"10th_percentile":5894.76,"90th_percentile":5894.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Endovascular Procedures","code_information":[{"code":"5193","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11941.67,"10th_percentile":11936.67,"90th_percentile":18906.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":29062.25,"10th_percentile":29062.25,"90th_percentile":29062.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11452.1,"10th_percentile":11452.1,"90th_percentile":11452.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":39386.45,"10th_percentile":39386.45,"90th_percentile":39386.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12133.2,"10th_percentile":12133.2,"90th_percentile":12133.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Electrophysiologic Procedures","code_information":[{"code":"5211","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1225.74,"10th_percentile":1225.74,"90th_percentile":1225.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Electrophysiologic Procedures","code_information":[{"code":"5212","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":7845.28,"10th_percentile":7845.28,"90th_percentile":7845.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Electrophysiologic Procedures","code_information":[{"code":"5213","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":48742.18,"10th_percentile":48742.18,"90th_percentile":48742.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":49958.29,"10th_percentile":49958.29,"90th_percentile":49958.29},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":24745.72,"10th_percentile":24745.72,"90th_percentile":24746.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":25860.41,"10th_percentile":25860.41,"90th_percentile":25860.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Pacemaker and Similar Procedures","code_information":[{"code":"5222","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":8556.48,"10th_percentile":8556.48,"90th_percentile":8556.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8350.5,"10th_percentile":8350.5,"90th_percentile":8350.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8847.97,"10th_percentile":8847.97,"90th_percentile":8847.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Pacemaker and Similar Procedures","code_information":[{"code":"5223","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11020.43,"10th_percentile":11020.43,"90th_percentile":11020.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Pacemaker and Similar Procedures","code_information":[{"code":"5224","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19254.85,"10th_percentile":19254.85,"90th_percentile":19254.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 ICD and Similar Procedures","code_information":[{"code":"5231","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":21462.36,"10th_percentile":21462.36,"90th_percentile":21462.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":23279.07,"10th_percentile":23279.07,"90th_percentile":23279.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 ICD and Similar Procedures","code_information":[{"code":"5232","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32358.61,"10th_percentile":32358.61,"90th_percentile":32358.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":633.93,"10th_percentile":633.93,"90th_percentile":633.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":822.48,"10th_percentile":822.48,"90th_percentile":822.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":806.73,"10th_percentile":806.73,"90th_percentile":806.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":407.67,"10th_percentile":407.67,"90th_percentile":407.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":5520.23,"10th_percentile":5520.23,"90th_percentile":5520.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1079.0,"10th_percentile":1079.0,"90th_percentile":1079.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":1888.14,"10th_percentile":1842.16,"90th_percentile":3728.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":3198.51,"10th_percentile":3103.86,"90th_percentile":3258.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":969.33,"10th_percentile":969.33,"90th_percentile":1234.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":1006.98,"10th_percentile":1006.98,"90th_percentile":1006.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":1421.45,"10th_percentile":946.12,"90th_percentile":1694.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1418.18,"10th_percentile":1418.18,"90th_percentile":1418.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1866.95,"10th_percentile":988.16,"90th_percentile":3290.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2000.83,"10th_percentile":2000.83,"90th_percentile":2000.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":1263.81,"10th_percentile":1263.81,"90th_percentile":1263.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":2037.45,"10th_percentile":2037.45,"90th_percentile":2037.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":4564.89,"10th_percentile":4564.89,"90th_percentile":4564.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2003.49,"10th_percentile":2003.49,"90th_percentile":2003.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":1657.91,"10th_percentile":1657.91,"90th_percentile":4768.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":3016.99,"10th_percentile":2925.72,"90th_percentile":3932.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":4779.58,"10th_percentile":4779.58,"90th_percentile":4779.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":983.43,"10th_percentile":983.43,"90th_percentile":983.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1871.5,"10th_percentile":1871.5,"90th_percentile":1871.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":668.72,"10th_percentile":668.72,"90th_percentile":668.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":6292.41,"10th_percentile":6292.41,"90th_percentile":6292.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":960.92,"10th_percentile":960.92,"90th_percentile":960.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"14","median_amount":2115.84,"10th_percentile":1996.05,"90th_percentile":2756.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1245.19,"10th_percentile":1245.19,"90th_percentile":1861.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":3150.63,"10th_percentile":3052.31,"90th_percentile":4221.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":1703.72,"10th_percentile":1703.72,"90th_percentile":1703.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":5637.01,"10th_percentile":5637.01,"90th_percentile":5637.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":1270.6,"10th_percentile":1270.6,"90th_percentile":1270.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1787.87,"10th_percentile":1191.0,"90th_percentile":2259.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3390.65,"10th_percentile":3390.65,"90th_percentile":3390.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":6913.55,"10th_percentile":6913.55,"90th_percentile":6913.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":322.28,"10th_percentile":322.28,"90th_percentile":322.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1830.93,"10th_percentile":1830.93,"90th_percentile":2362.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":85.56,"10th_percentile":85.56,"90th_percentile":85.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":10525.03,"10th_percentile":10525.03,"90th_percentile":10525.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3715.2,"10th_percentile":3715.2,"90th_percentile":3726.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3592.4,"10th_percentile":3592.4,"90th_percentile":3593.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7644.03,"10th_percentile":7644.03,"90th_percentile":7644.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":20436.7,"10th_percentile":20436.7,"90th_percentile":20436.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3645.13,"10th_percentile":3645.13,"90th_percentile":3645.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5342","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6778.25,"10th_percentile":6778.25,"90th_percentile":6778.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6299.17,"10th_percentile":6299.17,"90th_percentile":6299.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":3152.79,"10th_percentile":3152.79,"90th_percentile":18425.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10963.97,"10th_percentile":10963.97,"90th_percentile":10963.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":13470.26,"10th_percentile":8104.09,"90th_percentile":22389.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":6042.91,"10th_percentile":6042.91,"90th_percentile":6042.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":25704.26,"10th_percentile":25704.26,"90th_percentile":26275.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":6266.36,"10th_percentile":6266.36,"90th_percentile":6270.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5887.77,"10th_percentile":5887.18,"90th_percentile":5917.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11994.93,"10th_percentile":11994.93,"90th_percentile":12400.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3060.35,"10th_percentile":2519.63,"90th_percentile":3108.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":27935.36,"10th_percentile":18906.82,"90th_percentile":32979.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":439.75,"10th_percentile":439.75,"90th_percentile":439.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6059.1,"10th_percentile":6059.1,"90th_percentile":6149.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":24894.61,"10th_percentile":24894.61,"90th_percentile":24894.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":46771.63,"10th_percentile":46771.63,"90th_percentile":46771.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":702.55,"10th_percentile":702.55,"90th_percentile":702.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":690.09,"10th_percentile":690.09,"90th_percentile":690.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":317.75,"10th_percentile":317.75,"90th_percentile":317.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":703.49,"10th_percentile":703.49,"90th_percentile":703.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2164.45,"10th_percentile":2164.45,"90th_percentile":2164.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":4267.91,"10th_percentile":4267.91,"90th_percentile":8964.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":2121.99,"10th_percentile":2121.99,"90th_percentile":2121.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":9849.13,"10th_percentile":9849.13,"90th_percentile":9849.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":2200.19,"10th_percentile":2200.19,"90th_percentile":2200.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2069.17,"10th_percentile":2069.17,"90th_percentile":2070.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2118.18,"10th_percentile":2118.18,"90th_percentile":2163.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":6699.03,"10th_percentile":6699.03,"90th_percentile":13987.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":3570.52,"10th_percentile":3570.52,"90th_percentile":3570.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":12711.77,"10th_percentile":12711.77,"90th_percentile":12711.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":3780.03,"10th_percentile":3780.03,"90th_percentile":3780.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3478.8,"10th_percentile":3478.8,"90th_percentile":3478.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3635.11,"10th_percentile":3635.11,"90th_percentile":3635.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":10259.99,"10th_percentile":10259.99,"90th_percentile":10259.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5355.59,"10th_percentile":5355.59,"90th_percentile":5355.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":9890.18,"10th_percentile":7425.96,"90th_percentile":12671.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":5255.93,"10th_percentile":5255.93,"90th_percentile":5255.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":19063.15,"10th_percentile":19063.15,"90th_percentile":19063.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":5460.04,"10th_percentile":5460.04,"90th_percentile":5460.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5129.09,"10th_percentile":5129.09,"90th_percentile":5129.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":483.41,"10th_percentile":483.41,"90th_percentile":483.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5272.25,"10th_percentile":5272.25,"90th_percentile":5272.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 6 Urology and Related Services","code_information":[{"code":"5376","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":16076.33,"10th_percentile":16076.33,"90th_percentile":16076.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":9564.61,"10th_percentile":9564.61,"90th_percentile":9584.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3223.59,"10th_percentile":3223.59,"90th_percentile":3223.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"14","median_amount":1076.32,"10th_percentile":328.53,"90th_percentile":4002.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"40","median_amount":672.86,"10th_percentile":365.11,"90th_percentile":1491.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"16","median_amount":1124.91,"10th_percentile":796.16,"90th_percentile":1776.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":794.46,"10th_percentile":572.18,"90th_percentile":794.46},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":255.6,"10th_percentile":138.08,"90th_percentile":383.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":677.49,"10th_percentile":412.95,"90th_percentile":1169.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":313.07,"10th_percentile":142.1,"90th_percentile":313.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"42","median_amount":310.11,"10th_percentile":140.76,"90th_percentile":395.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":1436.47,"10th_percentile":1436.47,"90th_percentile":1436.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"44","median_amount":128.22,"10th_percentile":119.54,"90th_percentile":236.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":9302.39,"10th_percentile":8955.49,"90th_percentile":12163.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":3295.4,"10th_percentile":3295.4,"90th_percentile":3295.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":18410.82,"10th_percentile":18410.82,"90th_percentile":18410.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":8874.9,"10th_percentile":8874.9,"90th_percentile":8874.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":5107.81,"10th_percentile":5107.81,"90th_percentile":5107.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":23776.2,"10th_percentile":23776.2,"90th_percentile":23776.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":8760.86,"10th_percentile":8760.86,"90th_percentile":8760.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":5813.06,"10th_percentile":5247.24,"90th_percentile":9662.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":2018.95,"10th_percentile":2018.95,"90th_percentile":2018.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1977.55,"10th_percentile":1977.55,"90th_percentile":1977.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":923.72,"10th_percentile":923.72,"90th_percentile":923.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":12638.81,"10th_percentile":12638.81,"90th_percentile":12638.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":568.86,"10th_percentile":568.86,"90th_percentile":568.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":310.25,"10th_percentile":310.25,"90th_percentile":310.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":167.13,"10th_percentile":167.13,"90th_percentile":167.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":447.65,"10th_percentile":447.65,"90th_percentile":447.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9.99,"10th_percentile":9.99,"90th_percentile":672.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":734.46,"10th_percentile":725.86,"90th_percentile":2343.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":725.8,"10th_percentile":725.8,"90th_percentile":725.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":2543.19,"10th_percentile":2543.19,"90th_percentile":2543.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":753.99,"10th_percentile":753.99,"90th_percentile":753.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":977.8,"10th_percentile":977.8,"90th_percentile":977.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":466.87,"10th_percentile":466.87,"90th_percentile":466.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":507.38,"10th_percentile":507.38,"90th_percentile":507.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":728.06,"10th_percentile":728.06,"90th_percentile":739.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":42.71,"10th_percentile":42.71,"90th_percentile":42.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"56","median_amount":558.87,"10th_percentile":194.88,"90th_percentile":914.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"50","median_amount":93.28,"10th_percentile":92.68,"90th_percentile":191.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"88","median_amount":185.05,"10th_percentile":100.16,"90th_percentile":505.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"23","median_amount":91.03,"10th_percentile":91.03,"90th_percentile":91.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"1 through 10","median_amount":151.31,"10th_percentile":132.93,"90th_percentile":344.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"39","median_amount":511.77,"10th_percentile":53.25,"90th_percentile":1510.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":94.57,"10th_percentile":94.57,"90th_percentile":94.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":71.19,"10th_percentile":71.19,"90th_percentile":71.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"62","median_amount":89.06,"10th_percentile":88.81,"90th_percentile":89.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":180.74,"10th_percentile":180.74,"90th_percentile":398.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":42.71,"10th_percentile":42.71,"90th_percentile":42.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"31","median_amount":37.37,"10th_percentile":37.37,"90th_percentile":85.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"33","median_amount":155.3,"10th_percentile":155.3,"90th_percentile":763.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"20","median_amount":59.77,"10th_percentile":59.77,"90th_percentile":119.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"52","median_amount":91.32,"10th_percentile":91.32,"90th_percentile":188.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":83.81,"10th_percentile":83.81,"90th_percentile":83.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"81","median_amount":346.18,"10th_percentile":214.9,"90th_percentile":1066.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"74","median_amount":112.53,"10th_percentile":111.93,"90th_percentile":224.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"133","median_amount":312.84,"10th_percentile":167.74,"90th_percentile":754.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"68","median_amount":109.94,"10th_percentile":109.94,"90th_percentile":219.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"1 through 10","median_amount":566.56,"10th_percentile":305.1,"90th_percentile":699.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"52","median_amount":324.07,"10th_percentile":216.87,"90th_percentile":1604.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":114.21,"10th_percentile":114.21,"90th_percentile":241.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":404.51,"10th_percentile":404.51,"90th_percentile":404.51},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":108.44,"10th_percentile":108.44,"90th_percentile":108.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"109","median_amount":108.26,"10th_percentile":107.26,"90th_percentile":215.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"54","median_amount":218.28,"10th_percentile":218.28,"90th_percentile":436.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":66.6,"10th_percentile":42.71,"90th_percentile":83.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"61","median_amount":65.97,"10th_percentile":37.37,"90th_percentile":156.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"54","median_amount":286.15,"10th_percentile":286.15,"90th_percentile":882.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"40","median_amount":59.77,"10th_percentile":59.77,"90th_percentile":119.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"85","median_amount":110.29,"10th_percentile":109.84,"90th_percentile":223.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":183.74,"10th_percentile":183.74,"90th_percentile":183.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"36","median_amount":1053.39,"10th_percentile":543.49,"90th_percentile":2162.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"22","median_amount":255.42,"10th_percentile":254.42,"90th_percentile":258.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"42","median_amount":905.91,"10th_percentile":673.34,"90th_percentile":1904.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"20","median_amount":249.91,"10th_percentile":249.91,"90th_percentile":249.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"1 through 10","median_amount":996.76,"10th_percentile":996.76,"90th_percentile":996.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"15","median_amount":709.88,"10th_percentile":709.88,"90th_percentile":709.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":373.82,"10th_percentile":373.82,"90th_percentile":373.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":245.56,"10th_percentile":244.31,"90th_percentile":332.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":496.18,"10th_percentile":496.18,"90th_percentile":5932.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":558.53,"10th_percentile":558.53,"90th_percentile":558.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":110.54,"10th_percentile":110.54,"90th_percentile":457.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"18","median_amount":580.78,"10th_percentile":580.78,"90th_percentile":1161.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":59.77,"10th_percentile":59.77,"90th_percentile":119.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":250.68,"10th_percentile":250.68,"90th_percentile":569.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":678.14,"10th_percentile":579.9,"90th_percentile":1856.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":577.12,"10th_percentile":577.12,"90th_percentile":688.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"11","median_amount":1233.88,"10th_percentile":1084.41,"90th_percentile":2560.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":566.88,"10th_percentile":566.88,"90th_percentile":566.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"1 through 10","median_amount":1821.64,"10th_percentile":1821.64,"90th_percentile":1821.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":1785.24,"10th_percentile":1785.24,"90th_percentile":1785.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":588.9,"10th_percentile":588.9,"90th_percentile":588.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":554.14,"10th_percentile":553.04,"90th_percentile":555.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1125.51,"10th_percentile":1125.51,"90th_percentile":1125.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":1785.24,"10th_percentile":1785.24,"90th_percentile":2071.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":119.54,"10th_percentile":59.77,"90th_percentile":568.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":568.64,"10th_percentile":568.64,"90th_percentile":773.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":217.25,"10th_percentile":217.25,"90th_percentile":217.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"15","median_amount":1179.46,"10th_percentile":477.68,"90th_percentile":3559.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"24","median_amount":450.19,"10th_percentile":187.38,"90th_percentile":461.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"22","median_amount":1545.19,"10th_percentile":727.19,"90th_percentile":2272.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":184.05,"10th_percentile":184.05,"90th_percentile":5980.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"1 through 10","median_amount":2920.09,"10th_percentile":2920.09,"90th_percentile":2920.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":546.94,"10th_percentile":275.41,"90th_percentile":1564.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":467.33,"10th_percentile":467.33,"90th_percentile":467.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":438.88,"10th_percentile":180.31,"90th_percentile":447.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":893.17,"10th_percentile":893.17,"90th_percentile":893.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":78.79,"10th_percentile":2.88,"90th_percentile":83.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"12","median_amount":1284.16,"10th_percentile":656.36,"90th_percentile":1916.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":119.54,"10th_percentile":119.54,"90th_percentile":119.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":358.94,"10th_percentile":184.62,"90th_percentile":458.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"28","median_amount":1206.74,"10th_percentile":628.33,"90th_percentile":2447.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"29","median_amount":377.4,"10th_percentile":375.9,"90th_percentile":379.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"48","median_amount":1263.32,"10th_percentile":524.14,"90th_percentile":2350.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"23","median_amount":369.23,"10th_percentile":369.23,"90th_percentile":460.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"1 through 10","median_amount":1116.38,"10th_percentile":1116.38,"90th_percentile":1116.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"14","median_amount":1275.22,"10th_percentile":939.49,"90th_percentile":1698.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":383.57,"10th_percentile":383.57,"90th_percentile":918.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":362.47,"10th_percentile":360.37,"90th_percentile":363.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":733.09,"10th_percentile":733.09,"90th_percentile":733.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":290.22,"10th_percentile":290.22,"90th_percentile":290.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":46.23,"10th_percentile":46.23,"90th_percentile":46.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"17","median_amount":1193.56,"10th_percentile":652.31,"90th_percentile":2376.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":119.54,"10th_percentile":119.54,"90th_percentile":716.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"39","median_amount":376.4,"10th_percentile":370.38,"90th_percentile":480.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1520.36,"10th_percentile":1520.36,"90th_percentile":1520.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":3004.47,"10th_percentile":3004.47,"90th_percentile":3004.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":1493.4,"10th_percentile":1493.4,"90th_percentile":1493.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1456.93,"10th_percentile":1456.93,"90th_percentile":1456.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":239.08,"10th_percentile":239.08,"90th_percentile":239.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1189.76,"10th_percentile":1189.76,"90th_percentile":1189.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":748.45,"10th_percentile":748.45,"90th_percentile":748.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":423.45,"10th_percentile":423.45,"90th_percentile":423.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":615.17,"10th_percentile":615.17,"90th_percentile":615.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":415.45,"10th_percentile":415.45,"90th_percentile":415.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":1579.82,"10th_percentile":1579.82,"90th_percentile":1579.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":405.91,"10th_percentile":405.91,"90th_percentile":406.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":248.88,"10th_percentile":248.88,"90th_percentile":248.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":1161.94,"10th_percentile":1161.94,"90th_percentile":1161.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":119.54,"10th_percentile":119.54,"90th_percentile":119.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":416.74,"10th_percentile":416.74,"90th_percentile":416.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":954.06,"10th_percentile":954.06,"90th_percentile":954.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":570.26,"10th_percentile":570.26,"90th_percentile":570.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":615.06,"10th_percentile":615.06,"90th_percentile":615.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":556.51,"10th_percentile":556.51,"90th_percentile":556.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":1387.26,"10th_percentile":1387.26,"90th_percentile":1387.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":545.87,"10th_percentile":545.87,"90th_percentile":545.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1104.91,"10th_percentile":1104.91,"90th_percentile":1104.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":1759.73,"10th_percentile":1759.73,"90th_percentile":1759.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":558.24,"10th_percentile":558.24,"90th_percentile":558.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":2430.08,"10th_percentile":2430.08,"90th_percentile":2430.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":5210.15,"10th_percentile":5210.15,"90th_percentile":5210.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1318.52,"10th_percentile":1318.52,"90th_percentile":1318.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":5438.75,"10th_percentile":5438.75,"90th_percentile":5438.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1922.56,"10th_percentile":1922.56,"90th_percentile":1922.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Nuclear Medicine and Related Services","code_information":[{"code":"5594","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":1897.28,"10th_percentile":1806.43,"90th_percentile":14111.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1538.96,"10th_percentile":1536.76,"90th_percentile":5106.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":1536.69,"10th_percentile":1200.94,"90th_percentile":4959.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":1512.07,"10th_percentile":1508.02,"90th_percentile":5016.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"1 through 10","median_amount":1304.37,"10th_percentile":1304.37,"90th_percentile":1304.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":4741.83,"10th_percentile":4741.83,"90th_percentile":4741.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":934.73,"10th_percentile":934.73,"90th_percentile":934.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":1472.95,"10th_percentile":1471.2,"90th_percentile":5069.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3002.12,"10th_percentile":3002.12,"90th_percentile":3002.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2.88,"10th_percentile":2.88,"90th_percentile":2.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":3777.46,"10th_percentile":3777.46,"90th_percentile":3777.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":122.69,"10th_percentile":122.69,"90th_percentile":122.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1512.71,"10th_percentile":1512.71,"90th_percentile":1913.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5612","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":499.97,"10th_percentile":499.97,"90th_percentile":499.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5613","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3654.06,"10th_percentile":3654.06,"90th_percentile":3654.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Radiation Therapy","code_information":[{"code":"5623","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":8701.45,"10th_percentile":8701.45,"90th_percentile":8701.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12945.75,"10th_percentile":12945.75,"90th_percentile":12945.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":70.58,"10th_percentile":70.58,"90th_percentile":70.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":172.84,"10th_percentile":172.84,"90th_percentile":172.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":177.72,"10th_percentile":177.72,"90th_percentile":177.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":5752.0,"10th_percentile":5752.0,"90th_percentile":5752.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2268.85,"10th_percentile":2268.85,"90th_percentile":2268.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":339.49,"10th_percentile":339.49,"90th_percentile":339.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":196.64,"10th_percentile":196.64,"90th_percentile":196.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":891.36,"10th_percentile":891.36,"90th_percentile":891.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":486.94,"10th_percentile":486.94,"90th_percentile":486.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":496.9,"10th_percentile":326.56,"90th_percentile":793.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":249.65,"10th_percentile":222.56,"90th_percentile":249.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"43","median_amount":792.98,"10th_percentile":588.89,"90th_percentile":1288.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"15","median_amount":265.53,"10th_percentile":217.83,"90th_percentile":313.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":1810.8,"10th_percentile":1810.8,"90th_percentile":1810.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":226.29,"10th_percentile":226.29,"90th_percentile":226.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"17","median_amount":180.81,"10th_percentile":180.81,"90th_percentile":333.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":212.51,"10th_percentile":212.51,"90th_percentile":212.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":432.5,"10th_percentile":432.5,"90th_percentile":1328.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":42.23,"10th_percentile":42.23,"90th_percentile":42.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":184.32,"10th_percentile":184.32,"90th_percentile":508.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":1286.18,"10th_percentile":1234.02,"90th_percentile":1993.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"20","median_amount":187.99,"10th_percentile":119.54,"90th_percentile":410.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"48","median_amount":236.03,"10th_percentile":218.51,"90th_percentile":263.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":74.71,"10th_percentile":74.71,"90th_percentile":195.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":165.18,"10th_percentile":165.18,"90th_percentile":165.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":141.75,"10th_percentile":141.75,"90th_percentile":158.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":230.0,"10th_percentile":230.0,"90th_percentile":230.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":157.82,"10th_percentile":157.82,"90th_percentile":157.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":162.26,"10th_percentile":162.26,"90th_percentile":162.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":333.01,"10th_percentile":333.01,"90th_percentile":333.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":260.23,"10th_percentile":260.23,"90th_percentile":260.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":321.96,"10th_percentile":321.96,"90th_percentile":321.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":1735.06,"10th_percentile":1735.06,"90th_percentile":1735.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":166.08,"10th_percentile":166.08,"90th_percentile":166.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":779.98,"10th_percentile":779.98,"90th_percentile":779.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":240.29,"10th_percentile":240.29,"90th_percentile":240.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":59.77,"10th_percentile":59.77,"90th_percentile":59.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":1773.93,"10th_percentile":1225.93,"90th_percentile":3215.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":2608.47,"10th_percentile":1438.97,"90th_percentile":2697.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":3774.07,"10th_percentile":3774.07,"90th_percentile":3774.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1027.69,"10th_percentile":1027.69,"90th_percentile":1028.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2088.44,"10th_percentile":2088.44,"90th_percentile":2088.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":501.64,"10th_percentile":501.64,"90th_percentile":501.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":3774.07,"10th_percentile":3774.07,"90th_percentile":3774.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":59.77,"10th_percentile":59.77,"90th_percentile":1055.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1055.14,"10th_percentile":1055.14,"90th_percentile":1055.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":61.99,"10th_percentile":61.99,"90th_percentile":61.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":429.59,"10th_percentile":171.77,"90th_percentile":652.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":63.21,"10th_percentile":62.51,"90th_percentile":63.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":81.78,"10th_percentile":44.74,"90th_percentile":266.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":61.41,"10th_percentile":61.41,"90th_percentile":61.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":17.38,"10th_percentile":17.38,"90th_percentile":17.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":25.24,"10th_percentile":17.71,"90th_percentile":42.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":201.6,"10th_percentile":201.6,"90th_percentile":201.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":59.77,"10th_percentile":59.77,"90th_percentile":59.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":62.6,"10th_percentile":62.6,"90th_percentile":187.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":504.07,"10th_percentile":402.89,"90th_percentile":692.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":135.68,"10th_percentile":135.68,"90th_percentile":135.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":337.58,"10th_percentile":337.58,"90th_percentile":337.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"1 through 10","median_amount":137.32,"10th_percentile":137.32,"90th_percentile":137.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":485.84,"10th_percentile":485.84,"90th_percentile":485.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":192.23,"10th_percentile":192.23,"90th_percentile":192.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":130.02,"10th_percentile":130.02,"90th_percentile":167.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":106.13,"10th_percentile":106.13,"90th_percentile":106.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":495.48,"10th_percentile":495.48,"90th_percentile":495.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":150.7,"10th_percentile":150.7,"90th_percentile":150.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":130.59,"10th_percentile":130.59,"90th_percentile":130.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":1817.32,"10th_percentile":1817.32,"90th_percentile":1817.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":4531.95,"10th_percentile":4531.95,"90th_percentile":4531.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":689.69,"10th_percentile":689.69,"90th_percentile":689.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":89.76,"10th_percentile":89.76,"90th_percentile":89.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":190.98,"10th_percentile":190.98,"90th_percentile":190.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"1 through 10","median_amount":197.46,"10th_percentile":197.46,"90th_percentile":197.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":276.32,"10th_percentile":276.32,"90th_percentile":364.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"310","median_amount":339.08,"10th_percentile":94.87,"90th_percentile":706.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"50","median_amount":45.12,"10th_percentile":20.61,"90th_percentile":167.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"52","median_amount":511.73,"10th_percentile":138.29,"90th_percentile":1017.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"17","median_amount":36.71,"10th_percentile":13.78,"90th_percentile":107.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"1 through 10","median_amount":55.43,"10th_percentile":55.43,"90th_percentile":1116.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"32","median_amount":462.41,"10th_percentile":275.58,"90th_percentile":1183.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":131.92,"10th_percentile":70.65,"90th_percentile":166.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":33.49,"10th_percentile":8.73,"90th_percentile":77.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":48.58,"10th_percentile":24.92,"90th_percentile":189.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"33","median_amount":109.08,"10th_percentile":37.49,"90th_percentile":327.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"60","median_amount":18.39,"10th_percentile":4.32,"90th_percentile":61.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"48","median_amount":809.73,"10th_percentile":197.38,"90th_percentile":1412.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":47.13,"10th_percentile":12.6,"90th_percentile":172.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"113","median_amount":73.68,"10th_percentile":24.69,"90th_percentile":149.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":52.98,"10th_percentile":34.76,"90th_percentile":214.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":413.75,"10th_percentile":413.75,"90th_percentile":413.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":412.92,"10th_percentile":275.28,"90th_percentile":825.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":56.84,"10th_percentile":56.84,"90th_percentile":56.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"39","median_amount":34.76,"10th_percentile":23.17,"90th_percentile":164.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":81.89,"10th_percentile":76.86,"90th_percentile":287.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"89","median_amount":242.97,"10th_percentile":242.97,"90th_percentile":281.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"29","median_amount":111.44,"10th_percentile":111.44,"90th_percentile":122.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"117","median_amount":166.01,"10th_percentile":153.8,"90th_percentile":199.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"28","median_amount":109.47,"10th_percentile":109.47,"90th_percentile":109.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"1 through 10","median_amount":199.34,"10th_percentile":199.34,"90th_percentile":199.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"38","median_amount":747.99,"10th_percentile":516.47,"90th_percentile":747.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":113.72,"10th_percentile":113.72,"90th_percentile":113.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":197.34,"10th_percentile":197.34,"90th_percentile":197.34},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":45.35,"10th_percentile":45.35,"90th_percentile":45.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":106.8,"10th_percentile":106.8,"90th_percentile":106.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":217.35,"10th_percentile":217.35,"90th_percentile":217.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":46.67,"10th_percentile":46.67,"90th_percentile":46.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":46.23,"10th_percentile":46.23,"90th_percentile":46.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"38","median_amount":317.7,"10th_percentile":317.7,"90th_percentile":317.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":59.77,"10th_percentile":59.77,"90th_percentile":109.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"33","median_amount":109.36,"10th_percentile":109.36,"90th_percentile":111.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":333.66,"10th_percentile":268.69,"90th_percentile":434.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":219.01,"10th_percentile":170.08,"90th_percentile":273.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"1 through 10","median_amount":273.73,"10th_percentile":273.73,"90th_percentile":273.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":1027.17,"10th_percentile":1027.17,"90th_percentile":1027.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 50.1] [Cardiac Cath (%BC): 50.1] [Observation (%BC): 56.1] [Emergency Department (%BC): 56.1] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 50.1] [Occupational Therapy (%BC): 50.1] [Physical Therapy (%BC): 50.1] [Respiratory Services/Therapy  (%BC): 50.1] [Speech Therapy (%BC): 50.1] [All Other OP (%BC): 50.1]","count":"1 through 10","median_amount":236.54,"10th_percentile":228.76,"90th_percentile":620.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 50.5] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 50.5] [Physical Therapy (%BC): 50.5] [Respiratory Services/Therapy  (%BC): 50.5] [Speech Therapy (%BC): 50.5] [All Other OP (%BC): 50.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 28.89] [Cardiac Cath (%BC): 28.89] [Lithotripsy (%BC): 28.89] [PTCA (%BC): 28.89] [Observation (%BC): 46.59] [Emergency Department (%BC): 46.59] [Other Cardiac Testing (%BC): 39.08] [EEG (%BC): 39.08] [Chemotherapy (%BC): 39.08] [Nuclear Medicine (%BC): 13.05] [Radiation Therapy  (%BC): 39.08] [CT OP Scan (%BC): 13.05] [MRI OP (%BC): 13.05] [Positron Emission Tomography (%BC): 13.05] [Radiology (%BC): 13.05] [Laboratory (%BC): 39.08] [Occupational Therapy (%BC): 39.08] [Physical Therapy (%BC): 39.08] [Respiratory Services/Therapy  (%BC): 39.08] [Speech Therapy (%BC): 39.08] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 39.08] [All Other OP (%BC): 39.08]","count":"1 through 10","median_amount":153.72,"10th_percentile":138.97,"90th_percentile":191.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 11.0474]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.21] [Cardiac Cath (%BC): 33.21] [Lithotripsy (%BC): 33.21] [PTCA (%BC): 33.21] [Observation (%BC): 48.87] [Emergency Department (%BC): 48.87] [Other Cardiac Testing (%BC): 42.02] [EEG (%BC): 42.02] [Chemotherapy (%BC): 42.02] [Nuclear Medicine (%BC): 15.67] [Radiation Therapy  (%BC): 42.02] [CT OP Scan (%BC): 15.67] [MRI OP (%BC): 15.67] [Positron Emission Tomography (%BC): 15.67] [Radiology (%BC): 15.67] [Laboratory (%BC): 42.02] [Occupational Therapy (%BC): 42.02] [Physical Therapy (%BC): 42.02] [Respiratory Services/Therapy  (%BC): 42.02] [Speech Therapy (%BC): 42.02] [Other Outpatient Implant (%BC): 21.54] [IV Therapy (%BC): 42.02] [All Other OP (%BC): 42.02]","count":"1 through 10","median_amount":184.58,"10th_percentile":184.58,"90th_percentile":184.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Cardiac Cath (%BC): 58.8] [Observation (%BC): 61.7] [Emergency Department (%BC): 61.7] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 58.8] [Observation (%BC): 42.9] [Emergency Department (%BC): 42.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 58.8] [Physical Therapy (%BC): 58.8] [Respiratory Services/Therapy  (%BC): 58.8] [Speech Therapy (%BC): 58.8] [All Other OP (%BC): 58.8]","count":"1 through 10","median_amount":2488.51,"10th_percentile":820.69,"90th_percentile":2488.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone marrow transplant","code_information":[{"code":"009","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyphema","code_information":[{"code":"043","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein ligation & stripping","code_information":[{"code":"119","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W Cc/Mcc Or Major Device","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O Cc/Mcc","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W Cc/Mcc","code_information":[{"code":"131","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"G.I. hemorrhage w CC","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"214","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopy & Incisional Tubal Interruption","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endoscopic Tubal Interruption","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization & Radio-Implant, for Malignancy","code_information":[{"code":"363","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization Except for Malignancy","code_information":[{"code":"364","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures","code_information":[{"code":"365","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, female reproductive system w CC","code_information":[{"code":"366","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w CC","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & Non-Acute Leukemia w/o CC","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Childhood Mental Disorders","code_information":[{"code":"431","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning & toxic Effects of Drugs Age >17 w CC","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications of treatment w CC","code_information":[{"code":"452","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","code_information":[{"code":"484","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","code_information":[{"code":"490","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w/o CC/MCC","code_information":[{"code":"491","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient ischemia","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"527","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Proc w Pdx Hemorrhage","code_information":[{"code":"528","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular shunt procedures w CC","code_information":[{"code":"529","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures w/o CC","code_information":[{"code":"530","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w CC","code_information":[{"code":"531","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w/o CC","code_information":[{"code":"532","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","code_information":[{"code":"567","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","code_information":[{"code":"568","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small & Large Bowel Procedures w CC w Major Gi Dx","code_information":[{"code":"569","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Admit For Renal Dialysis","code_information":[{"code":"685","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W Cc/Mcc","code_information":[{"code":"691","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","code_information":[{"code":"692","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W Cc/Mcc","code_information":[{"code":"765","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W/O Cc/Mcc","code_information":[{"code":"766","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Sterilization &/Or D&C","code_information":[{"code":"767","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Complicating Diagnoses","code_information":[{"code":"774","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W/O Complicating Diagnoses","code_information":[{"code":"775","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ectopic Pregnancy","code_information":[{"code":"777","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Threatened Abortion","code_information":[{"code":"778","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"False Labor","code_information":[{"code":"780","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W Medical Complications","code_information":[{"code":"781","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W/O Medical Complications","code_information":[{"code":"782","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","code_information":[{"code":"984","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","code_information":[{"code":"985","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","code_information":[{"code":"986","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Ppo","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155397 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2263] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2263] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Rehab-Per Diem: 1911] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 20000 (%BC): 23.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12410.6,"10th_percentile":12410.6,"90th_percentile":12410.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 206980 | Total % of Charge: 53.01] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3629] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"1 through 10","median_amount":30912.84,"10th_percentile":30912.84,"90th_percentile":30912.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 165583 | Total % of Charge: 55.55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 4291] [IP Prosthetics/Implants/Devices (%BC): 21.54]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156446 | Total % of Charge: 58.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16028 Days: 3 Additional Days: 2005] [Normal vag. Del. 2 day stay-Case Rate: 11219 Days: 2 Additional Days: 2005] [Nursery  Level 1- Boarder-Per Diem: 1203] [Nursery  Level 2-Per Diem: 2085] [Nursery  Level 3-Per Diem: 5210] [Nursery  Level 4-NICU-Per Diem: 6252] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 24005 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9713.4,"10th_percentile":9713.4,"90th_percentile":9713.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 646362.96 | Total % of Charge: 26.23] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14925.59 Days: 4 Additional Days: 1842.66] [Normal vag. Del. 2 day stay-Case Rate: 10011.81 Days: 2 Additional Days: 1842.66] [Nursery  Level 1- Boarder-Per Diem: 921.33] [Nursery  Level 2-Per Diem: 1719.82] [Nursery  Level 3-Per Diem: 3685.33] [Nursery  Level 4-NICU-Per Diem: 4299.55] [Psych-Per Diem: 2088.35] [Rehab-Per Diem: 3777.46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2835.2,"10th_percentile":2835.2,"90th_percentile":2835.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131703 | Total % of Charge: 52.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1655] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1655] [Nursery  Level 1- Boarder-Per Diem: 1117] [Nursery  Level 2-Per Diem: 2088] [Nursery  Level 3-Per Diem: 4922] [Nursery  Level 4-NICU-Per Diem: 5518] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 39407 (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2557.11,"10th_percentile":2557.11,"90th_percentile":2557.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6714.36,"10th_percentile":6714.36,"90th_percentile":6714.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"J1885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":0.30,"maximum":0.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":0.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":0.31,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":0.32,"additional_payer_notes":"APC"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":0.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - 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